Provider Demographics
NPI:1316298771
Name:CLARKE, CHRISTINE ELAINE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELAINE
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:781 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2850
Mailing Address - Country:US
Mailing Address - Phone:832-289-0509
Mailing Address - Fax:
Practice Address - Street 1:17080 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:832-289-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX575249363LF0000X
TXAP122005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily