Provider Demographics
NPI:1316567753
Name:EREMENKO, ANTONINA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:EREMENKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 WASHINGTON AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4215
Mailing Address - Country:US
Mailing Address - Phone:786-673-4029
Mailing Address - Fax:
Practice Address - Street 1:1370 WASHINGTON AVE STE 224
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4215
Practice Address - Country:US
Practice Address - Phone:786-673-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily