Melissa D. Clark, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9102703 Issued in FL

Practice address

909 N Dale Mabry Hwy
Tampa, FL 33609-1251

Phone

(813) 978-9700

Fax

(813) 978-9700

NPI assigned

Jul 28, 2006

Last updated

Feb 16, 2015By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Musculoskeletal Institute Chartered

  • Orthopaedic Surgery Physician
  • Zephyrhills, FL
  • NPI 1467305839
  NPD (past)
• St Josephs Specialty Services Inc

  • Surgery Physician
  • Tampa, FL
  • NPI 1750411237
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424044800000",
    "number": "1407860166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370925",
            "telephone_number": "813-978-9700",
            "fax_number": "813-558-6186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091251",
            "telephone_number": "813-978-9700",
            "fax_number": "813-978-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MELISSA",
        "middle_name": "D.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292088300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Clark
• Lauren Clark, MD
• Leah Diane Clark, ARNP
• Margaret Clark, LCSW
• Matthew Clark
• Michael E Clark, PH.D.
• Nataly Milagros Clark
• Nicolette M Clark, MD
• Nina Clark
• Samantha Clark, LCSW

• Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.