Robert Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN1295281 Issued in FL

Practice address

26347 Lake Lindsey Rd
Brooksville, FL 34601-4304

Phone

(352) 650-3825

Fax

(352) 799-5200

NPI assigned

Apr 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396963666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 171",
            "city": "ISTACHATTA",
            "state": "FL",
            "postal_code": "346360171",
            "telephone_number": "352-650-3825",
            "fax_number": "352-799-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26347 LAKE LINDSEY RD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346014304",
            "telephone_number": "352-650-3825",
            "fax_number": "352-799-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROBERT",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN1295281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN",
            "identifier": "PN1295281",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gary L Clark, PA C
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• Paula Arlene Cochrane, B.A.

• Licensed Practical Nurse in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.