Healthcare Provider Details

I. General information

NPI: 1255676839
Provider Name (Legal Business Name): LESLIE ANN CLARK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 386
OCOEE FL
34761-3400
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 386
OCOEE FL
34761-3435
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1990
  • Fax: 407-296-1992
Mailing address:
  • Phone: 407-296-1990
  • Fax: 407-296-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9277706
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9277706
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9277706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: