Individual
DAVID ANTICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
34 SMITH RD, NEWPORT, RI 02841-1007
(401) 841-4170
Mailing address
34 SMITH RD, NEWPORT, RI 02841-1007
(401) 841-4170
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN585298PA
PA
363LF0000X
Family Nurse Practitioner
Primary
SP013584
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14030003000461
MEDICARE DCN
—
Enumeration date
05/29/2013
Last updated
03/07/2023
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