Provider Demographics
NPI:1023219292
Name:FEARON-CLARKE, JACQUELINE ELIZABETH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JACQUELINE
Middle Name:ELIZABETH
Last Name:FEARON-CLARKE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-971-4179
Mailing Address - Fax:973-290-7905
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-971-4179
Practice Address - Fax:973-290-7905
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR74702363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care