Andrea Clark
Individual provider Active NPI Primary Care Nurse Practitioner · Glenside, PA
NPI 1992598379 · NPPES record last updated May 27, 2025
Key facts
- NPI
- 1992598379
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- SP032962 (PA)
- Practice address
- 721 N Tyson Ave
Glenside, PA 19038-3845 - Phone
- (267) 921-8158
- NPI assigned
- May 27, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4055 Valley View LN
Suite 700
Dallas, TX 75244-4910
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250924004941 | PA | Practitioner - Nurse Practitioner | 0648775270 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP032962 | PA | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signify Health Medical Associates, PLLC | Single Specialty | Current |
Accepting new patients |
Locations
600 N 2nd St
Ste 401
Harrisburg, PA 17101
Phone (844) 341-2339
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
4055 Valley View Ln
Ste 700
Dallas, TX 75244
Phone (469) 466-7424
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner |
363LP2300X | SP032962 | PA | Yes |
Addresses
Primary practice location
721 N Tyson Ave
Glenside, PA 19038-3845
Mailing address
721 N Tyson Ave
Glenside, PA 19038-3845
Phone (215) 571-9692
Other providers in Glenside, PA
- Child and Family Focus, Inc.
- Janice Chon
- Davonyaa Christy
- Citadel Home Care, LLC
- Citadel Home Care, LLC
- Heather E Clark
- Kelley Ann Coady
- Justin Cobb
- Howard Cohen
- Tahira Collier
All providers in Glenside, PA · Primary Care Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.