Provider Demographics
NPI:1295942365
Name:CLARKE, CAROLYN MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:KILLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2310 ELLA PL
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2722
Mailing Address - Country:US
Mailing Address - Phone:727-418-1241
Mailing Address - Fax:
Practice Address - Street 1:4131 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8229
Practice Address - Country:US
Practice Address - Phone:727-327-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP893022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner