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General NPI Number Information
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NPI Number | 1255440475
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Entity Type | Individual
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Provider Name | SCOTT CLARK PA
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1503 BUENOS AIRES BLVD STE 100
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City | THE VILLAGES
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State | FL
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Zip | 32159-6825
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Country | US
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Telephone | 352-753-2812
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Fax | 352-753-0537
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Provider Business Mailing Address
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Address Line | 151 SOUTHHALL LN STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7172
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Country | US
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Telephone | 407-875-2080
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Fax | 407-650-3455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3724
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License Number State | FL
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