Provider Demographics
NPI:1609832906
Name:ANTOINE-LAROCHE, MARIEYVES EDMEY (ARNP-BC OR CRNP)
Entity Type:Individual
Prefix:
First Name:MARIEYVES
Middle Name:EDMEY
Last Name:ANTOINE-LAROCHE
Suffix:
Gender:F
Credentials:ARNP-BC OR CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-8839
Mailing Address - Country:US
Mailing Address - Phone:863-421-3204
Mailing Address - Fax:
Practice Address - Street 1:1700 BAKER AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-8839
Practice Address - Country:US
Practice Address - Phone:863-421-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188836363L00000X
FLARNP2140882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009462700Medicaid
FLY08N8OtherFLORIDA BLUE
FLU6568ZMedicare ID - Type Unspecified
FLY08N8OtherFLORIDA BLUE