Provider Demographics
NPI:1154131878
Name:CLARKE, PATRICIA RENE CLERVIL
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RENE CLERVIL
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CHEEVER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1126
Mailing Address - Country:US
Mailing Address - Phone:617-980-9921
Mailing Address - Fax:
Practice Address - Street 1:545 E JOHN CARPENTER FWY STE 400
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8131
Practice Address - Country:US
Practice Address - Phone:888-523-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2343659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily