Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jonathan B. Clark, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1275923781

Jonathan B. Clark, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Providence, Rhode Island. Qualified in 2015, 11 years ago. Practices with Coastal Medical Associates, a 446-clinician group. Licensed in Massachusetts and Rhode Island.

Years since qualifying
11
Licensed in
MA, RI
In the registry since
2015
Specialties on file
2
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

164 Summit Ave
Providence, RI 02906-2853
Phone: (401) 793-4575
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence APRN00302 (RI)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence RN277232 (MA)

Record details

NPI number1275923781
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedFebruary 4, 2015
Last updated in NPPESSeptember 16, 2021
Certification dateSeptember 16, 2021
Mailing address333 Ricciuti Dr, Apt. 1824, Quincy, MA 02169-6287

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Coastal Medical Associates — 446 clinicians
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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