Provider Demographics
NPI:1831428028
Name:STARK, CLAUDENE KOROS (FNP)
Entity type:Individual
Prefix:
First Name:CLAUDENE
Middle Name:KOROS
Last Name:STARK
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 1:1150 BAKER STREET
Mailing Address - Street 2:MINUTE CLINIC
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-662-7517
Mailing Address - Fax:949-722-1750
Practice Address - Street 1:1150 BAKER STREET
Practice Address - Street 2:MINUTE CLINIC
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-662-7517
Practice Address - Fax:949-722-1750
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45158363LF0000X
CA19532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily