CANDACE CLARK (NPI# 1821448820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821448820 |
| Entity Type | Individual |
| Full Name | CANDACE CLARK |
| Practice Address |
17008 Sw 39th St Miramar FL 33027-4614 |
| Mailing Address |
2114 N Flamingo Rd #169 Pembroke Pines FL 33028-3501 |
| Practice Telephone | 7862322902 |
| Mailing Telephone | 7862322902 |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2016-06-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 016651300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376166579 | Candace Ann Clark | Physician Assistant | 7237 Wellauer Dr, Wauwatosa, WI 53213-3665 | 2020-05-21 |
| 1609297431 | Candace Clark | Dietitian, Registered | 1615 Delware Street, Longview, WA 98632 | 2013-12-20 |
| 1437775095 | Candace Danielle Clark | Counselor | 4211 Government Blvd, Mobile, AL 36693-4813 | 2020-06-19 |
| 1619534203 | Candace Clark | Social Worker | 13136 Western Ave, Blue Island, IL 60406-2423 | 2019-05-20 |
| 1629327101 | Candace Clark | Counselor | 202 East Bagley Road, Berea, OH 44017-2058 | 2012-08-30 |
| Street Address |
17008 SW 39TH ST |
| City | MIRAMAR |
| State | FL |
| Zip Code | 33027-4614 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474808 | A&d Community Mental Health, LLC | Community/Behavioral Health | 1333 Sw 16th Ave, Pembroke Pines, FL 33027 | 2020-10-12 |
| 1275172256 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 12681 Miramar Parkway, Miramar, FL 33027 | 2019-12-23 |
| 1902449424 | Marine M Brown | Nurse Practitioner | 4343 Sw 128th Avenue, Mirmar, FL 33027 | 2019-10-28 |
| 1427699107 | Suncare Therapy, Inc | Physical Therapist | 111 Grant Palms Dr, Pembroke Pines, FL 33027 | 2019-10-03 |
| 1245888080 | Nicole Angelique Munoz | Nurse Practitioner | 12600 Pembroke Rd Ste 200, Miramar, FL 33027 | 2019-08-26 |
| 1770052334 | Katalyst Health, LLC | Family Medicine | 14704 Sw 11 Street, Pembroke Pines, FL 33027 | 2018-11-13 |
| 1700362076 | Jovani Miguel Gonzalez | Dentist | 3600 Sw 163rd Ave, Miramar, FL 33027 | 2018-07-19 |
| 1336648310 | Janelle Monique Mitchell | Behavior Technician | 3350 Sw 148th Ave Suite 110, Miramar, FL 33027 | 2018-02-06 |
| 1437667557 | Elizabeth Connors | Specialist/Technologist | 17089 Sw 16th St, Pembroke Pines, FL 33027 | 2018-01-11 |
| 1992217806 | Bibi Farida Roberts | Counselor | 3590 Sw 142nd Ave, Miramar, FL 33027 | 2017-11-01 |
| Find all providers in zip 33027 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346866209 | Jerusalem Group Home LLC | Clinic/Center | 2440 Sw 82nd Ter, Miramar, FL 33025-2134 | 2020-06-17 |
| 1316586167 | Pauliana Balthazar | Clinic/Center | 6757 Sw 27th Ct, Miramar, FL 33023-4801 | 2019-12-26 |
| 1447762497 | Asz Caring Hearts Healthcare Inc | Clinic/Center | 9992 Periwinkle St, Miramar, FL 33025-3234 | 2017-10-31 |
| 1730631474 | All Star Care Services LLC | Clinic/Center | 7971 Riviera Blvd Ste 433, Miramar, FL 33023-6451 | 2016-10-28 |
| 1467091165 | Wholesome Loving Care | Clinic/Center | 6757 Sw 27th Ct, Miramar, FL 33023-4801 | 2019-12-27 |
| 1013562479 | Excelsior Deluxe Care Inc | Clinic/Center | 9230 N Cypress Cir, Miramar, FL 33025-2440 | 2019-08-02 |
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| 1578164463 | Jamesas Williams | Clinic/Center | 880 Piedmont Dr Se, Winter Haven, FL 33880-4547 | 2020-11-05 |
| 1942801964 | Aleyda P Blanco | Clinic/Center | 11177 Sw 8th St Apt 308, Pembroke Pines, FL 33025-6987 | 2020-11-05 |
| 1619578978 | Mays Caring Home LLC | Clinic/Center | 103 Shaw Blvd, Fort Myers, FL 33905-2632 | 2020-11-03 |
| 1801497235 | Precious Dreams Group Home #2, Inc. | Clinic/Center | 820 Nw 32nd Ave, Miami, FL 33125-3906 | 2020-11-03 |
| 1619578192 | Elsyoff Care Center LLC | Clinic/Center | 1727 Nw 19th Ter, Cape Coral, FL 33993-4915 | 2020-11-02 |
| 1417558099 | Trnity Fields Inc | Clinic/Center | 12210 Netherfield Ct, Riverview, FL 33569-4117 | 2020-11-02 |
| 1891395430 | Kettia Noel | Clinic/Center | 1573 Se Clearbrook St, Port Saint Lucie, FL 34983-4050 | 2020-10-30 |
| 1740880871 | Salubrious Home Therapy Services, Inc | Clinic/Center | 3421 Sw 114th Ct, Miami, FL 33165-3330 | 2020-10-28 |
| 1407456718 | Evelyne Charles | Clinic/Center | 3301 White Blossom Ln, Clermont, FL 34711-6366 | 2020-10-27 |
| 1295334191 | Aging At Home LLC | Clinic/Center | 1858 Forest Hills Rd, Jacksonville, FL 32208-2535 | 2020-10-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.