Individual
DR. NICHOLAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1285 CREEKSIDE BLVD E UNIT 102, NAPLES, FL 34109-0595
(239) 624-4200
(239) 624-0311
Mailing address
1285 CREEKSIDE BLVD E UNIT 102, NAPLES, FL 34109-0595
(239) 624-1700
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
60704
MN
207X00000X
Orthopaedic Surgery Physician
MD61156092
WA
207XS0117X
Orthopaedic Surgery of the Spine Physician
MD61156092
WA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
ME166354
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121214100
—
FL
01
—
O7SZB
BCBS
FL
Enumeration date
05/19/2015
Last updated
09/05/2024
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