Healthcare Provider Details

I. General information

NPI: 1891800421
Provider Name (Legal Business Name): ATHENA ATKINSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD SUITE 300
WELLINGTON FL
33414-3164
US

IV. Provider business mailing address

770 NORTHPOINT PARKWAY SUITE 102
WEST PALM BEACH FL
33407
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-5990
  • Fax: 561-790-5952
Mailing address:
  • Phone: 561-275-7604
  • Fax: 561-802-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP1973572
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP1973572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: