Individual
MRS. NICOLE MARIE ANTENUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9109691
FL
363AM0700X
Medical Physician Assistant
MA052460
PA
Other
Enumeration date
06/04/2009
Last updated
01/06/2022
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