Susan Marie Clark, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11007813 Issued in FL

Practice address

300 Treemonte Dr
Orange City, FL 32763-7977

Phone

(800) 614-4124

Fax

(888) 217-4124

NPI assigned

Jul 9, 2020

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Behavioral Healthcare LLCGroup PAC ID 7810162740, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: susan.clark@087.emedpractice.direct-ci.com

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.

• Mindful Behavioral Healthcare, LLC

  • Community/Behavioral Health Agency
  • Kissimmee, FL
  • NPI 1477744548
  Medicare reassignment Care Compare group
• Coastal Mental Health Center Inc

  • Community/Behavioral Health Agency
  • Sanford, FL
  • NPI 1154594950
  NPD (past)
• Coastal Mental Health Center Inc

  • Community/Behavioral Health Agency
  • Orange City, FL
  • NPI 1174270037
  NPD (past)
• Mindful Integrated Medicine LLC

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1831544832
  NPD (past)

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

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787529600000",
    "number": "1376161950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 W SR 434 STE 101",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327506269",
            "telephone_number": "800-614-4124",
            "fax_number": "888-217-4124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TREEMONTE DR",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327637977",
            "telephone_number": "800-614-4124",
            "fax_number": "888-217-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11007813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chy-Ching Chuang, PT
• Morad Chughtai, MD
• Tatianna Ciambra
• Joseph Anthony Ciccone, RPH
• Circle of Life Wellness, Inc.
• Katie Elizabeth Cline, OTR/L
• CLN Therapeutic Solutions
• David Clymer, DPT, PT, ATC. LAT
• Coast Florida P.a.
• Coastal Mental Health Center Inc

• Psychiatric/Mental Health Nurse Practitioner in Orange City, FL
• Providers in Orange City, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.