Healthcare Provider Details

I. General information

NPI: 1760329825
Provider Name (Legal Business Name): SAMANTHA ANNA-LEIGH CLARK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20099 OFFICE CIR STE 208
GEORGETOWN DE
19947-3196
US

IV. Provider business mailing address

20099 OFFICE CIR STE 208
GEORGETOWN DE
19947-3196
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-1773
  • Fax:
Mailing address:
  • Phone: 302-856-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013815
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: