Provider Demographics
NPI:1629657333
Name:ANTINUCCI, DANIEL J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:ANTINUCCI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6060 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6610
Mailing Address - Country:US
Mailing Address - Phone:570-249-0834
Mailing Address - Fax:
Practice Address - Street 1:9123 N MILITARY TRL STE 103
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-5968
Practice Address - Country:US
Practice Address - Phone:570-249-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered