Healthcare Provider Details

I. General information

NPI: 1790180107
Provider Name (Legal Business Name): ANTONELLA MARCHIONNA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SPILLWAY RD
BRANDON MS
39047-6066
US

IV. Provider business mailing address

P O BOX 2153 DEPT 1947
BIRMINGHAM AL
35287-0001
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-5532
  • Fax: 601-992-5547
Mailing address:
  • Phone: 601-292-4562
  • Fax: 601-974-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR876088
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: