Individual
JESUS ANTATICO MACROHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1417 SEABREEZE ST, CLEARWATER, FL 33756-2348
(727) 309-1004
Mailing address
1417 SEABREEZE ST, CLEARWATER, FL 33756-2348
(727) 446-8004
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN11006709
FL
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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