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Individual

ANDRISE ANTOINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
518 NW KILPATRICK AVE, PORT ST LUCIE, FL 34983-8719
(772) 672-5238
Mailing address
518 NW KILPATRICK AVE, PORT ST LUCIE, FL 34983-8719

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CNA 108781
FL

Other

Enumeration date
07/03/2007
Last updated
07/08/2007
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