Individual
MRS. NICOLE MARIE ANTENUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1 JARRETT WHITE RD, TAMC, TRIPLER ARMY MEDICAL CENTER, HI 96859-5001
(808) 433-7699
Mailing address
3 SHIRCLIFF WAY, STE 714, JACKSONVILLE, FL 32204-4786
(814) 590-5495
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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