Provider Demographics
NPI:1619929908
Name:CLERGE, ROSELINE CARLINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSELINE
Middle Name:CARLINE
Last Name:CLERGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-0730
Mailing Address - Country:US
Mailing Address - Phone:386-734-0121
Mailing Address - Fax:386-734-0332
Practice Address - Street 1:112 E NEW YORK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5504
Practice Address - Country:US
Practice Address - Phone:386-734-0121
Practice Address - Fax:386-734-0332
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9217032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily