Provider Demographics
NPI:1215561063
Name:CLARK, HELEN CHRISTINE (CNM, FNP)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:CHRISTINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:CHRISTINA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 MCLAREN GATES DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6983
Mailing Address - Country:US
Mailing Address - Phone:912-674-8984
Mailing Address - Fax:
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-955-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN10006202367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife