Jennifer Ford Clark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11034207 Issued in FL

Practice address

1410 Nautilus Dr
Navarre, FL 32566-7441

Phone

(571) 512-2063

NPI assigned

Dec 18, 2024

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1734480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1124836556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 NAUTILUS DR",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325667441",
            "telephone_number": "571-512-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 NAUTILUS DR",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325667441",
            "telephone_number": "571-512-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "FORD",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-18",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11034207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chayil Christian Counseling Services, LLC
• Elise C Chisholm, LCSW
• Christine Rushford
• Christopher B Cave MD PLLC
• Breanne Clark
• Sarah Mae Clark
• Kalli Donaway Clement
• Coastal Vascular and Interventional PLLC
• Ellen Elizabeth Coats, MD
• Taylor Collins

• Family Nurse Practitioner in Navarre, FL
• Providers in Navarre, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.