Provider Demographics
NPI:1417679176
Name:CLARK, SHINIKA (NP, PMHNP)
Entity type:Individual
Prefix:
First Name:SHINIKA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 PELICAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1381
Mailing Address - Country:US
Mailing Address - Phone:386-206-8068
Mailing Address - Fax:386-206-8069
Practice Address - Street 1:1190 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1381
Practice Address - Country:US
Practice Address - Phone:386-206-8069
Practice Address - Fax:386-206-8069
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9392948163WR0400X
FLAPRN11022123363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation