Healthcare Provider Details

I. General information

NPI: 1033348677
Provider Name (Legal Business Name): FLORA ADELAIDE ANTWI-MILLER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E HICKORY ST
SPRING VALLEY NY
10977-3707
US

IV. Provider business mailing address

324 E 149TH ST
BRONX NY
10451-5602
US

V. Phone/Fax

Practice location:
  • Phone: 845-573-9662
  • Fax:
Mailing address:
  • Phone: 718-665-4300
  • Fax: 718-665-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335438-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006377
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335438-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: