MEDICARE: KAYLA NICOLE CLARK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	9120458	FL

General Provider Information

NPI Number	:	1770466021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA NICOLE CLARK PA-C

Provider Business Mailing Address
First Line	:	2995 DREW ST FL 2
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 MEASE DR STE 200
Second Line	:
City	:	SAFETY HARBOR
State	:	FL
Zip	:	34695-6604
Country	:	US
Telephone Number	:	727-724-8611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	02/05/2026

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Directions to “ KAYLA NICOLE CLARK PA-C” Practice Location

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