Healthcare Provider Details

I. General information

NPI: 1376400580
Provider Name (Legal Business Name): JAVIER ENRIQUE ANTIQUE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBATION PLACE
CELEBRATION FL
34747
US

IV. Provider business mailing address

1169 WOODS LANDING DR
MINNEOLA FL
34715-6067
US

V. Phone/Fax

Practice location:
  • Phone: 407-764-4370
  • Fax:
Mailing address:
  • Phone: 407-491-9256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9373366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: