Shinika Clark, NP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11022123 Issued in FL

Practice address

1190 Pelican Bay Dr
Daytona Beach, FL 32119-1381

Phone

(386) 206-8069

Fax

(386) 206-8069

NPI assigned

Sep 19, 2022

Last updated

Sep 10, 2024By 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

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Renew Restore Revise Psychiatric Services, LLC

  • Psychiatry Physician
  • Palm Coast, FL
  • NPI 1891516324
  Medicare reassignment NPD Authorized official
• The Helping Hand of Tomorrow, Inc

  dba A Helping Hand Inc.

  • Psychiatry Physician
  • Daytona Beach, FL
  • NPI 1376974881
  Medicare reassignment NPD

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

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1417679176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 PELICAN BAY DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321191381",
            "telephone_number": "386-206-8068",
            "fax_number": "386-206-8069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 PELICAN BAY DR",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321191381",
            "telephone_number": "386-206-8069",
            "fax_number": "386-206-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHINIKA",
        "credential": "NP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-19",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11022123",
            "primary": true
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "FL",
            "license": "RN9392948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina M Clark, MS
• Deborah Clark
• Destanee Joy Clark
• Kevin S Clark, M.M.S., PA-C
• Rita Clark
• Mark Anthony Clarke, M.D.
• Rollins Clary, DMD
• Kathryn Frances Clay, MA, CAP, LMHC
• Lloyd Wayne Clayborn
• Elizabeth Cleavall

• Psychiatric/Mental Health Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, 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 Sep 10, 2024; 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.