Provider Demographics
NPI:1003176322
Name:ANTIGUA SUAREZ, NATHALY (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHALY
Middle Name:
Last Name:ANTIGUA SUAREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 THOMASVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3400
Mailing Address - Country:US
Mailing Address - Phone:863-934-6230
Mailing Address - Fax:
Practice Address - Street 1:1157 THOMASVILLE CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3400
Practice Address - Country:US
Practice Address - Phone:863-934-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant