Provider Demographics
NPI:1972908242
Name:CLARKE, JAMIE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 TRIMINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7942
Mailing Address - Country:US
Mailing Address - Phone:412-657-0103
Mailing Address - Fax:
Practice Address - Street 1:2687 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4351
Practice Address - Country:US
Practice Address - Phone:850-848-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014207363LF0000X
FLAPRN11005041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily