MEDICARE: TONIA SHELLIE DAVY CLARKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11035287	FL
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	9547527	FL

General Provider Information

NPI Number	:	1225738107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA SHELLIE DAVY CLARKE

Provider Business Mailing Address
First Line	:	817 N DIXIE HWY STE 102
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-5621
Country	:	US
Telephone Number	:	954-785-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N UNIVERSITY DR STE 103A
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2001
Country	:	US
Telephone Number	:	954-218-6182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	04/21/2026

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