Healthcare Provider Details

I. General information

NPI: 1184475626
Provider Name (Legal Business Name): NANCY M ANTOINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW 145TH TER STE 116
PEMBROKE PINES FL
33027-1443
US

IV. Provider business mailing address

15292 SW 17TH ST
DAVIE FL
33326-2045
US

V. Phone/Fax

Practice location:
  • Phone: 844-447-5335
  • Fax:
Mailing address:
  • Phone: 786-246-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number06-44-1714677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: