Individual
SHINIKA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, PMHNP
Contact information
Practice address
1190 PELICAN BAY DR, DAYTONA BEACH, FL 32119-1381
(386) 206-8069
(386) 206-8069
Mailing address
1190 PELICAN BAY DR, DAYTONA BEACH, FL 32119-1381
(386) 206-8068
(386) 206-8069
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
RN9392948
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11022123
FL
Other
Enumeration date
09/19/2022
Last updated
09/10/2024
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