Provider Demographics
NPI:1477802684
Name:CLARKE, COLLETTE ANDREA (RN)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:ANDREA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LILLIE LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6358
Mailing Address - Country:US
Mailing Address - Phone:347-585-3598
Mailing Address - Fax:347-442-3100
Practice Address - Street 1:34 LILLIE LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6358
Practice Address - Country:US
Practice Address - Phone:347-585-3598
Practice Address - Fax:347-442-3100
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657617163W00000X, 163WH0200X, 171W00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171W00000XOther Service ProvidersContractor
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine