Timothy G Clark, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

ARNP2199692 Issued in FL

Practice address

12902 Usf Magnolia Dr
MDC 44
Tampa, FL 33612-9416

Phone

(813) 745-8486

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

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)

Enrolled

Practice roles

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.

• North Pinellas Anesthesia Associates, PA

  • Anesthesiology Physician
  • Tampa, FL
  • NPI 1104879816

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Unicom Anesthesia Associates, PA

  • Anesthesiology Physician
  • Tampa, FL
  • NPI 1649232299

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197590400000",
    "number": "1851492979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 917770",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328917770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12902 USF MAGNOLIA DR",
            "address_2": "MDC 44",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336129416",
            "telephone_number": "813-745-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMOTHY",
        "middle_name": "G",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP2199692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "G1360",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicolette M Clark, MD
• Nina Clark
• Samantha Clark, LCSW
• Stephanie Clark, LMHC
• Stephanie Ann Clark, RD, LD/N
• Vanessa Clark
• Mercedes Renee Clarke-Wright, LMFT
• Anna-Lee Clarke, MD
• Carol Biliston Clarke, MD
• Chanczlor Clarke

• Certified Registered Nurse Anesthetist in Tampa, FL
• Providers in Tampa, FL by specialty
• Certified Registered Nurse Anesthetist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; 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.