Samantha Clark, APRN-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11001826 Issued in FL

Practice address

5956 Turkey Lake Rd
Orlando, FL 32819-4218

Phone

(407) 830-0414

NPI assigned

Jul 25, 2017

Sex

Female

Sole proprietor

Yes

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 TX, 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, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.clark.1@9357.direct.athenahealth.com

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.

• Access Telecare, PLLC

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1013303080

  Multi-Specialty

  Medicare reassignment NPD
• Forefront Telecare Inc

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1174035612

  FL, Multi-Specialty

  Medicare reassignment NPD
• Rooted in Therapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Orlando, FL
  • NPI 1609675479

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1740703354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5956 TURKEY LAKE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328194218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5956 TURKEY LAKE RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328194218",
            "telephone_number": "407-830-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SAMANTHA",
        "credential": "APRN-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-25",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11001826",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11001826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Mary Clark
• Mark C Clark, MD
• Nicole Clark
• Rebecca Jo Clark, MSW
• Renette Clark
• Shaneen Clark, APRN
• Sharlynn Clark, COTA
• Sloan Clark
• Theresa A Clark, RDN/LDN, CSP
• Wandea Renea Clark

• Psychiatric/Mental Health Nurse Practitioner in Orlando, FL
• Providers in Orlando, 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 Feb 21, 2023; 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.