Provider Demographics
NPI:1336106160
Name:CLARKE, SHARON J (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:CLARKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8424
Mailing Address - Country:US
Mailing Address - Phone:804-893-8717
Mailing Address - Fax:804-594-3131
Practice Address - Street 1:14051 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 2210
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3201
Practice Address - Country:US
Practice Address - Phone:804-893-8717
Practice Address - Fax:804-594-3131
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165327363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN