Provider Demographics
NPI:1568143253
Name:PAUL, PASCALE ANTONINE
Entity Type:Individual
Prefix:
First Name:PASCALE
Middle Name:ANTONINE
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9871 WATERMILL CIR APT C
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2887
Mailing Address - Country:US
Mailing Address - Phone:347-888-3076
Mailing Address - Fax:
Practice Address - Street 1:9871 WATERMILL CIR APT C
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2887
Practice Address - Country:US
Practice Address - Phone:347-888-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM77393363LP0808X
TX1147111363LP0808X
FL11028223363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health