Individual
CHRISTINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8931 COLONIAL CENTER DR, SUITE 301, FORT MYERS, FL 33905-7809
(239) 334-6626
(239) 334-0404
Mailing address
PO BOX 2147, ATTN: PAYER CONTRACTING AND RELATIONS DEPT., FORT MYERS, FL 33902-2147
(239) 343-2123
(239) 343-2124
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9109027
FL
363A00000X
Physician Assistant
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129735100
—
FL
01
—
398575
AVMED
FL
01
—
4070865
CIGNA
FL
01
—
4765071
AETNA
FL
01
—
IMUXN
BCBS
FL
01
—
P01652163
RR MEDICARE
FL
Enumeration date
01/20/2015
Last updated
03/12/2026
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