Maribeth Collard Clark, CRNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

APRN11036078 Issued in FL

Practice address

6801 Airport Blvd
Hospitalist Dept.
Mobile, AL 36608-3709

Phone

(251) 639-5775

Fax

(251) 631-3581

NPI assigned

Jan 8, 2015

Last updated

Feb 13, 2025By 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 3

Addresses

Other names 1

• Maribeth Kathleen Collard-Clark Professional name

Medicare fee-for-service enrollment

Enrolled in AL, FL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, 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.

• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Pensacola, FL
  • NPI 1205614336
  Medicare reassignment Care Compare group NPD
• Providence Hospital

  • General Acute Care Hospital
  • Mobile, AL
  • NPI 1952390643
  Medicare reassignment NPD
• USA Health Community Providers LLC

  • Family Medicine Physician
  • Mobile, AL
  • NPI 1801571823
  Medicare reassignment NPD
• Providence Hospital

  • Hospitalist Physician
  • Mobile, AL
  • NPI 1871922971
  NPD
• Providence Hospital

  • Anesthesiology Physician
  • Mobile, AL
  • NPI 1992133912
  NPD
• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Los Angeles, CA
  • NPI 1205787686
  NPD
• University of South Alabama Mitchell Cancer Institute

  • Multi-Specialty Clinic/Center
  • Mobile, AL
  • NPI 1023210259
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sacred Heart Health System, Inc.

  dba Ascension Sacred Heart Pensacola

  • General Acute Care Hospital
  • Pensacola, FL
  • NPI 1922032424
  Care Compare affiliation

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

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1730577016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 AIRPORT BLVD",
            "address_2": "HOSPITALIST DEPT.",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366083709",
            "telephone_number": "251-639-5775",
            "fax_number": "251-631-3581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 AIRPORT BLVD",
            "address_2": "HOSPITALIST DEPT.",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366083709",
            "telephone_number": "251-639-5775",
            "fax_number": "251-631-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARIBETH",
        "middle_name": "COLLARD",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-08",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11036078",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "APRN11036078",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "AL",
            "license": "1-098071",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIBETH",
            "last_name": "COLLARD-CLARK",
            "middle_name": "KATHLEEN",
            "credential": "CRNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Emilee Clark, M.S.OTR/L
• Emily Ann Clark, DDS
• Hal J Clark, D.O.
• Jordan Ayana Clark
• Katie M Clark, PHARMD
• Marla Clark
• Melanie Helene Clark, MD
• Savannah Emily Clark
• Shawn B Clark, M.D.
• Tonya Lee Clark, PHARM. D

• Nurse Practitioner in Mobile, AL
• Providers in Mobile, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.