Jessica Lynn Clark

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11022604 Issued in FL

Practice address

4901 Market Place Rd
Pensacola, FL 32504-8986

Phone

(855) 527-7246

Fax

(833) 810-1165

NPI assigned

Nov 15, 2022

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

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

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 and National Provider Directory roles.

• Gulf Coast Pain Consultants LLC

  • Interventional Pain Medicine Physician
  • Pensacola, FL
  • NPI 1669712287
  Medicare reassignment NPD
• Privia Medical Group Florida, LLC

  • General Practice Physician
  • Indialantic, FL
  • NPI 1700649043
  Medicare reassignment NPD
• Gulf Coast Pain Consultants LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Walton Beach, FL
  • NPI 1083455299
  NPD
• Gulf Coast Pain Consultants LLC

  • Pain Medicine (Anesthesiology) Physician
  • Pensacola, FL
  • NPI 1265099386
  NPD

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1619686946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DEFENSE HWY STE 205",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017096",
            "telephone_number": "855-527-7246",
            "fax_number": "866-229-5063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 MARKET PLACE RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048986",
            "telephone_number": "855-527-7246",
            "fax_number": "833-810-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11022604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francesca Nicole Cirillo, M.D.
• Allison Clark, CCC-SLP
• Audriana Clark
• Bishod Q Clark
• Brittney Nichole Clark, LMHC
• John Henry Clark, CRNA
• Leigh Dell Clark, LMHC
• Melea Hopelyn Clark, PHARMD, RPH
• Michael Eugene Clark, CRNA
• Nathaniel Robert Clark, CRNA

• Nurse Practitioner in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.