Healthcare Provider Details

I. General information

NPI: 1285672063
Provider Name (Legal Business Name): SHARI A. CLARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 7TH AVE N
ST PETERSBURG FL
33705-1300
US

IV. Provider business mailing address

6135 30TH CT S
ST PETERSBURG FL
33712-4578
US

V. Phone/Fax

Practice location:
  • Phone: 727-865-1275
  • Fax:
Mailing address:
  • Phone: 727-865-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3023802
License Number StateFL

VIII. Authorized Official

Name: MASHARIA ANN CLARK
Title or Position: OWNER
Credential: ARNP
Phone: 727-687-7076