MEDICARE: CAROL SAN ANTONIO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	9324248	FL

General Provider Information

NPI Number	:	1316004161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SAN ANTONIO APRN

Provider Business Mailing Address
First Line	:	13141 CRISA DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-1442
Country	:	US
Telephone Number	:	561-629-5092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 SW MAPP RD
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2446
Country	:	US
Telephone Number	:	772-223-2633
Fax Number	:	772-223-2502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/10/2013

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