Provider Demographics
NPI:1356418875
Name:ANDERSON- CLARKE, BERNADINE CARLINE (ARNP)
Entity type:Individual
Prefix:MR
First Name:BERNADINE
Middle Name:CARLINE
Last Name:ANDERSON- CLARKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:BERNADINE
Other - Middle Name:CARLINE
Other - Last Name:ANDERSON- CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:8987 BIDDLE CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6436
Mailing Address - Country:US
Mailing Address - Phone:561-254-7933
Mailing Address - Fax:
Practice Address - Street 1:8987 BIDDLE CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6436
Practice Address - Country:US
Practice Address - Phone:561-254-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346597363LF0000X
FL9205733363LF0000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46-2835472Medicaid