Provider Demographics
NPI:1366945214
Name:CLARKE, VICTORIA (APN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WHITE HORSE PIKE STE 112
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1938
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:856-796-9183
Practice Address - Street 1:210 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1715
Practice Address - Country:US
Practice Address - Phone:856-546-3003
Practice Address - Fax:856-547-5337
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPENDING363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner