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General NPI Number Information
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NPI Number | 1568628139
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Entity Type | Individual
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Provider Name | CRANE ANTAWAN NIBLACK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1700 79TH STREET CSWY STE 120
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4197
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Country | US
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Telephone | 305-726-2177
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Fax | 305-726-2209
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101253456
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME163136
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License Number State | FL
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