Individual
JOAN MARIE ANTONUCCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10200 TURKEY LAKE RD, UNIT 134, ORLANDO, FL 32819-8017
(407) 968-7062
Mailing address
10200 TURKEY LAKE RD, UNTI 134, ORLANDO, FL 32819-8017
(407) 968-7062
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
687809179
PROVIDER NUMBER
FL
Enumeration date
04/09/2009
Last updated
04/09/2009
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