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

Nicolette M Clark, MD

Individual provider Surgery Physician · NPI 1174104111

Nicolette M Clark, MD is a Surgery Physician in Tampa, Florida. Practices as a sole proprietor and works from 2 locations. Licensed in Florida and Ohio.

Licensed in
FL, OH
In the registry since
2021
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

17 Davis Blvd Ste 308
Tampa, FL 33606-3438
Phone: (813) 974-2201
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 128 E Apple St, Dayton, OH 45409-2902 — (937) 208-4953

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X · Licence ME0180960 (FL)
Surgery Physician Taxonomy 208600000X · Licence 57.251172 (OH)

Record details

NPI number1174104111
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 20, 2021
Last updated in NPPESJune 1, 2026
Certification dateJune 1, 2026
Mailing address17 Davis Blvd Ste 308, Tampa, FL 33606-3438

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