Provider Demographics
NPI:1154615268
Name:CLARKE-ROMERO, COLLEEN (CRNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:CLARKE-ROMERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 ATLANTIC BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5283
Mailing Address - Country:US
Mailing Address - Phone:904-853-6396
Mailing Address - Fax:
Practice Address - Street 1:363 ATLANTIC BLVD STE 10
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-5283
Practice Address - Country:US
Practice Address - Phone:904-853-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9490624363L00000X
MDR169698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338700300Medicaid
MD225410Y3NMedicare PIN