Provider Demographics
NPI:1609121680
Name:ANTONELLO, OLIVIA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:ANTONELLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 PINECROFT DR STE 270
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3183
Mailing Address - Country:US
Mailing Address - Phone:936-447-9618
Mailing Address - Fax:
Practice Address - Street 1:9303 PINECROFT DR STE 270
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3183
Practice Address - Country:US
Practice Address - Phone:936-447-9618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily