Provider Demographics
NPI:1295493187
Name:ACTION WELLNESS NP IN FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:ACTION WELLNESS NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-500-0388
Mailing Address - Street 1:116 N HURON ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3532
Mailing Address - Country:US
Mailing Address - Phone:631-500-0388
Mailing Address - Fax:
Practice Address - Street 1:116 N HURON ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3532
Practice Address - Country:US
Practice Address - Phone:631-500-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY405889OtherNYSED BOARD OF NURSING
NY344753OtherNURSE PRACTITIONER LICENSE
1184999344OtherNPPES - NPI NUMBER