Provider Demographics
NPI:1649787532
Name:MARTIN-CLARKE, CHARMAINE ALECIA (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:ALECIA
Last Name:MARTIN-CLARKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 SAXON BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8425
Mailing Address - Country:US
Mailing Address - Phone:386-228-9700
Mailing Address - Fax:
Practice Address - Street 1:1133 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8425
Practice Address - Country:US
Practice Address - Phone:386-878-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily