Provider Demographics
NPI:1699854521
Name:TINAPUNAN, ANTOINETTE (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANTOINETTE
Middle Name:
Last Name:TINAPUNAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5318
Mailing Address - Country:US
Mailing Address - Phone:718-429-8979
Mailing Address - Fax:
Practice Address - Street 1:102-01 66TH ROAD
Practice Address - Street 2:NORTH SHORE/LIJ
Practice Address - City:FOREST
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-830-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant