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DEMETRIA ANGELICA CLARK PA
NPI 1104399849
Physician Assistant in Jacksonville, FL

Active since January 04, 2019
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224(904) 953-2000(904) 956-0381 Get Directions Write a Review

NPPES record last updated: December 21, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 24, 2021, Sep 19, 2021, Aug 21, 2020 and 2 more (5 updates tracked since 2019).

About Demetria Angelica Clark Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEMETRIA ANGELICA CLARK PA (NPI 1104399849) is an individual physician assistant in Jacksonville, Florida, licensed in Florida (PA9114358) and active in the NPI registry since January 2019.

NPPES Registry Identity

NPI1104399849
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameDEMETRIA ANGELICA CLARKCredential: PA
Location Address4500 SAN PABLO RD SJacksonville, FL 32224-1865
Mailing Address200 1st St SwRochester, MN 55905-0001 · (507) 284-2511
Phone(904) 953-2000
Fax(904) 956-0381
Sole ProprietorNo
Enumeration DateJanuary 4, 2019
Last NPPES UpdateDecember 21, 20235 updates tracked since enumeration
NPPES CertifiedDecember 21, 2023
✔ NPI 1104399849 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Licenses✔ Licensed in FL · PA9114358✔ Licensed in MN · 12918
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
4500 SAN PABLO RD S, Jacksonville, FL 32224
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE L WALSH PA-C/MPH
Physician Assistant
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
DR. JAMI ANN ROTHE KINNUCAN M.D.
Internal Medicine (Gastroenterology)
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
GLENN SHI MD
Orthopaedic Surgery
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
MICHELLE TULANG MD
Internal Medicine
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
RICARDO PAGAN MD
Hospitalist
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
CRYSTAL LYNN CRNA
Nurse Anesthetist, Certified Registered
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
LAUREN E FREED CRNA
Nurse Anesthetist, Certified Registered
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
MRS. MELINA VOLNER SOMMESE PA-C
Physician Assistant
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2594

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Demetria Clark's NPI number?

The NPI number for Demetria Clark is 1104399849. It was assigned to this individual provider in the NPPES registry on January 4, 2019.

Where is Demetria Clark located?

Demetria Clark practices at 4500 San Pablo Rd S, Jacksonville, FL 32224. The listed phone number is (904) 953-2000.

What is Demetria Clark's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Demetria Clark was last updated on December 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.