Individual provider Active NPI

Anne Clark, ARNP

  • Nurse Practitioner
  • Land O Lakes, FL
National Provider Identifier
1609899871
Registry record updated Oct 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP1600042 Issued in FL
Practice address
2100 Via Bella Blvd
Ste. 204
Land O Lakes, FL 34639-5429
Phone
(813) 751-3636
Fax
(813) 377-1678
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP1600042 FL Primary

Addresses

Primary practice location

2100 Via Bella Blvd
Ste. 204
Land O Lakes, FL 34639-5429

Mailing address

38135 Market Square
Zephrhills, FL 33542
Phone (813) 780-1255

Other identifiers 2

IdentifierTypeStateIssuer
300899100MedicaidFL
500014246OtherFLRR MEDICARE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100426000091 FL Practitioner - Nurse Practitioner 5092840306 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Medical Clinic, LLC CurrentSince Feb 15, 2010 Accepting new patients
Ohi West Medical Group II LLC CurrentSince May 1, 2024 Accepting new patients
Florida Medical Clinic LLC CurrentSince Feb 15, 2010 Accepting new patients
Ohi West Medical Group II LLC CurrentSince May 1, 2024 Accepting new patients

Locations

2100 Via Bella Blvd
Ste 204
Land O Lakes, FL 34639
Phone (813) 751-3636

2100 Via Bella Blvd
Ste 205
Land O Lakes, FL 34639
Phone (813) 528-4960

38135 Market Square Dr
Zephyrhills, FL 33542
Phone (352) 567-0188

38135 Market Square Dr
Ste 101
Zephyrhills, FL 33542
Phone (813) 788-7651

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1609899871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQUARE",
            "city": "ZEPHRHILLS",
            "state": "FL",
            "postal_code": "33542",
            "telephone_number": "813-780-1255",
            "fax_number": "813-780-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 VIA BELLA BLVD",
            "address_2": "STE. 204",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346395429",
            "telephone_number": "813-751-3636",
            "fax_number": "813-377-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANNE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2015-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP1600042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300899100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "500014246",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Land O Lakes, FL

Sources for this page

Verify at the official NPI Registry.