MEDICARE: MICHELLE ANDREA CLARKE PMHNP

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	11021688	FL

General Provider Information

NPI Number	:	1245951219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANDREA CLARKE PMHNP

Provider Business Mailing Address
First Line	:	12580 NW 57TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3469
Country	:	US
Telephone Number	:	954-415-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2728
Country	:	US
Telephone Number	:	954-415-2451
Fax Number	:

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	05/25/2023

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