NICOLETTE M CLARK MD
NPI 1174104111
Surgery - Vascular Surgery in Tampa, FL

Q: What is Nicolette Clark's NPI number?

The NPI number for Nicolette Clark is 1174104111. It was assigned to this individual provider in the NPPES registry on April 20, 2021.

Q: What is Nicolette Clark's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

Q: When was this NPI record last updated?

The NPPES record for Nicolette Clark was last updated on June 1, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 20, 2021PECOS Enrolled

17 DAVIS BLVD STE 308, TAMPA, FL 33606(813) 974-2201 Get Directions Write a Review

NPPES record last updated: June 1, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 1, 2026, Apr 20, 2021 (2 updates tracked since 2021).

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About Nicolette M Clark Md NPPES

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

NICOLETTE M CLARK MD (NPI 1174104111) is an individual vascular surgery provider in Tampa, Florida, licensed in Florida (ME0180960) and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Dayton.

NPPES Registry Identity

NPI1174104111

Entity TypeIndividualFemale

Primary Taxonomy2086S0129X

Provider Legal NameNICOLETTE M CLARKCredential: MD

Location Address17 DAVIS BLVD STE 308Tampa, FL 33606-3438

Mailing Address17 Davis Blvd Ste 308Tampa, FL 33606-3438 · (813) 974-2201

Phone(813) 974-2201

Sole ProprietorYes

Enumeration DateApril 20, 2021

Last NPPES UpdateJune 1, 20262 updates tracked since enumeration

NPPES CertifiedJune 1, 2026

✔ NPI 1174104111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0129X

License✔ Licensed in FL · ME0180960

Definition

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

Also ListedSurgeryTaxonomy 208600000X · License 57.251172 (OH)

17 DAVIS BLVD STE 308, Tampa, FL 33606

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Secondary Practice Location 1

Location 1128 E Apple StDayton, OH 45409-2902 · Phone (937) 208-4953

Other Identifiers 1

Other57.251172OH · Training Certificate (md)

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicolette M Clark Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33606 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$70.04 typical visit price

range $17.57 – $139.16

Typical copayment $17.51 (range $4.39 – $34.79)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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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.

MARISOL GOMEZ MD

Student in an Organized Health Care Education/Training Program