Provider Demographics
NPI:1710655006
Name:ROBERTSON, CLIVE E (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:E
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CLIVE
Other - Middle Name:E
Other - Last Name:TUCCERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 CHASE LN
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2295
Mailing Address - Country:US
Mailing Address - Phone:919-525-4960
Mailing Address - Fax:
Practice Address - Street 1:101 SHATTUCK WAY STE 6
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7876
Practice Address - Country:US
Practice Address - Phone:603-778-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2354385163W00000X, 363LF0000X
NC255804163W00000X
NY644410163W00000X
FL11018088363LF0000X
NH086438-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse