Healthcare Provider Details

I. General information

NPI: 1568423168
Provider Name (Legal Business Name): DESIREE A CLARKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 10TH AVE N STE 101
LAKE WORTH FL
33461-6609
US

IV. Provider business mailing address

3820 NORTHDALE BLVD STE 201
TAMPA FL
33624-1893
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax:
Mailing address:
  • Phone: 630-725-2730
  • Fax: 844-205-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberME151858
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME151858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: