Illise Clark, FNP-NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.0022454 Issued in OH

Practice address

8881 Schaeffer St
Mentor, OH 44060-5035

Phone

(440) 255-9309

NPI assigned

May 7, 2012

Last updated

May 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Uh Regional Hospitals

  dba Geauga House Providers

  • Nurse Practitioner
  • Chardon, OH
  • NPI 1962886002
  Medicare reassignment NPD
• Longevity Clinical LTC Associates of Ohio, Inc.

  • Gerontology Nurse Practitioner
  • Parma, OH
  • NPI 1114609815
  Medicare reassignment
• Uh Regional Hospitals

  dba UH Geauga Medical Center, A Campus of UH Regional Hospitals

  • Psychiatric Hospital Unit
  • Chardon, OH
  • NPI 1780762120
  NPD

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

{
    "created_epoch": "1336348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1396004776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8881 SCHAEFFER ST",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605035",
            "telephone_number": "440-255-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8881 SCHAEFFER ST",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440605035",
            "telephone_number": "440-255-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ILLISE",
        "credential": "FNP-NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-07",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0022454",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.371331",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0268768",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlyn Cirrincione
• City of Mentor Lake County (Mentor Fire Department)
• Deneen Claiborne, PHLEBOTOMIST
• Robert B Clapp, PCC
• Dagmar Clark, QMHS
• Marcy Clark
• Kyle Clawson
• Keli Clay
• Lyndsey Clemens, RPH
• Cleveland Clinic

• Family Nurse Practitioner in Mentor, OH
• Providers in Mentor, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.