Candace Clark

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

17008 SW 39TH St
Miramar, FL 33027-4614

Phone

(786) 232-2902

NPI assigned

Jun 21, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Jewel Learning, LLC

  • Developmentally Disabled Services Day Training Agency
  • Miramar, FL
  • NPI 1427715648
  NPD Authorized official
• Lotus Life Line Training, LLC

  • Home Health Agency
  • Miami, FL
  • NPI 1275270639
  NPD Authorized official

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466467200000",
    "number": "1821448820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 N FLAMINGO RD",
            "address_2": "#169",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330283501",
            "telephone_number": "786-232-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17008 SW 39TH ST",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330274614",
            "telephone_number": "786-232-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CANDACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016651300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Farrha-Loody Civil
• Hermence Saget Civil, FNP
• CJ Therapy Solution LLC
• Dawn H Clancy, MD
• Clarity Vision Center Inc.
• Tanisha Clark
• Shavel Clarke Ow, PHARM D
• Carol Joyce Clarke
• Whitney Clarke
• Claude B Romulus MD, MPH, PA

• Developmental Disabilities Clinic/Center in Miramar, FL
• Providers in Miramar, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.