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NPI Code Detail

MEDICARE: MR. CARLOS CLARKE

MEDICARE: MR. CARLOS 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
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1780533448
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARLOS CLARKE
Provider Business Mailing Address
First Line : 514 S HUNT CLUB BLVD
Second Line :
City : APOPKA
State : FL
Zip : 32703-4948
Country : US
Telephone Number : 407-613-2335
Fax Number :
Provider Business Practice Location Address
First Line : 514 S HUNT CLUB BLVD
Second Line :
City : APOPKA
State : FL
Zip : 32703-4948
Country : US
Telephone Number : 407-613-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2026
Last Update Date : 01/26/2026

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