Provider Demographics
NPI:1417633967
Name:ST. ANTOINE, CAROLINE COLETTE (CNIM)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:COLETTE
Last Name:ST. ANTOINE
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10491 GANDY BLVD N APT 2114
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2313
Mailing Address - Country:US
Mailing Address - Phone:404-565-3888
Mailing Address - Fax:
Practice Address - Street 1:3 MARYLAND FARMS, STE. 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:281-768-6743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3785246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic