Healthcare Provider Details

I. General information

NPI: 1174434757
Provider Name (Legal Business Name): MARY ANTOINETTE ILUMIN ARBITRARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23324 NW 178TH AVE
HIGH SPRINGS FL
32643-4283
US

IV. Provider business mailing address

23324 NW 178TH AVE
HIGH SPRINGS FL
32643-4283
US

V. Phone/Fax

Practice location:
  • Phone: 386-289-1761
  • Fax:
Mailing address:
  • Phone: 386-289-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number494425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: