Healthcare Provider Details

I. General information

NPI: 1811289432
Provider Name (Legal Business Name): EMMANUEL S ANTONIO FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2011
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LIMESTONE RD STE 7
WILMINGTON DE
19808-5553
US

IV. Provider business mailing address

2006 LIMESTONE RD STE 7
WILMINGTON DE
19808-5553
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-2383
  • Fax: 302-351-6261
Mailing address:
  • Phone: 302-355-2383
  • Fax: 302-351-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000559
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: