MICHAEL THOMAS CLARK CRNP NPI 1366547515

NPI Information

  • NPI: 1366547515
  • Provider Name: MICHAEL THOMAS CLARK, CRNP
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Individual
  • Address: 3400 SPRUCE ST
    GROUND SILVERSTEIN
    PHILADELPHIA, PA
    ZIP 19104
  • Phone: (215) 662-6963

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NPI Details

Michael Thomas Clark, CRNP is a nurse practitioner in Philadelphia, PA. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Michael Thomas Clark, CRNP NPI is 1366547515. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3400 SPRUCE ST
GROUND SILVERSTEIN
PHILADELPHIA, PA
ZIP 19104-206
Phone: (215) 662-6963

The enumeration date for this NPI number is 9/13/2006 and was last updated on 5/9/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerSP00179HPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1S44908MEDICARE UPINPENNSYLVANIA
2002260MEDICARE ID-TYPE UNSPECIFIEDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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