Healthcare Provider Details

I. General information

NPI: 1306677166
Provider Name (Legal Business Name): ANDREW CLARK SOBREPENA DNP, APRN-RX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HOBRON LN PH 1
HONOLULU HI
96815-1231
US

IV. Provider business mailing address

444 HOBRON LN PH 1
HONOLULU HI
96815-1231
US

V. Phone/Fax

Practice location:
  • Phone: 808-862-8795
  • Fax: 808-977-4417
Mailing address:
  • Phone: 808-862-8795
  • Fax: 808-977-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-6101
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-6101
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-114502
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: