Provider Demographics
NPI:1255368254
Name:CLARKE, ROSE MARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
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 1:1 PENN PLZ FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0899
Mailing Address - Country:US
Mailing Address - Phone:615-224-5438
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:ONE PENN PLAZA 8TH FLOOR
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:347-443-0692
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336294-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY125536825OtherNPI
Q09009Medicare UPIN