SAMUEL CLARK AGACNP NPI 1417706623

NPI Information

  • NPI: 1417706623
  • Provider Name: SAMUEL CLARK, AGACNP
  • Classification: Nurse Practitioner - 363LA2100X
  • Specialization: Acute Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4755 OGLETOWN STANTON RD STE 2E99
    NEWARK, DE
    ZIP 19718
  • Phone: (302) 733-5982

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NPI Details

Samuel Clark, AGACNP is an acute care nurse practitioner in Newark, DE with 5 years of experience. Samuel Clark, AGACNP NPI is 1417706623. 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:

4755 OGLETOWN STANTON RD STE 2E99
NEWARK, DE
ZIP 19718-200
Phone: (302) 733-5982
Fax: (302) 733-6081

The NPI 1417706623 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/20/2024 and was last updated on 7/12/2024.

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
1163W00000XRegistered NurseL1-0048020DELAWARENo
2363LG0600XNurse PractitionerGerontologyLP-0010513DELAWARENo
3363LA2100XNurse PractitionerAcute CareLP-0010513DELAWAREYes

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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