Provider Demographics
NPI:1114677713
Name:ANTOINE, ROSE CLAIRE (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CLAIRE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RAELIN RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1108
Mailing Address - Country:US
Mailing Address - Phone:203-589-0001
Mailing Address - Fax:
Practice Address - Street 1:17 RAELIN RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1108
Practice Address - Country:US
Practice Address - Phone:203-589-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAG03220092363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care