Individual
RAE ANN ANTONUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
122 NESBIT ST STE 112, PUNTA GORDA, FL 33950-3653
(941) 347-7707
Mailing address
122 NESBIT ST STE 112, PUNTA GORDA, FL 33950-3653
(941) 347-7707
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9105373
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
574430236A
—
GA
01
—
Y09FA
BC
FL
Enumeration date
02/07/2008
Last updated
04/20/2021
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