Nicole Renee Clark, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704190098 Issued in MI

Practice address

408 Meadow Brook Rd
Rochester, MI 48309-4452

Phone

(248) 370-2341

NPI assigned

Jun 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oakland University

  • Adult Health Nurse Practitioner
  • Rochester, MI
  • NPI 1841447117
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757116800000",
    "number": "1104021740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1563 ELCROFT CT",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483076062",
            "telephone_number": "586-219-7438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 MEADOW BROOK RD",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483094452",
            "telephone_number": "248-370-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-15",
        "last_updated": "2025-09-06",
        "certification_date": "2025-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704190098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• City of Rochester
• Amy M Clapp, MPT
• Debra Striler Clark, M.A., PSY.S, L.L.P.
• Jon B Clark, PHD
• Matthew Lewis Clark, MD
• Amy Elizabeth Cleland, MPT
• Matthew Sean Akira Clifford, M.D.
• Erica Cogswell
• Carolynne Coleman, RN
• Communicare Michigan LLC

• Family Nurse Practitioner in Rochester, MI
• Providers in Rochester, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.