Provider Demographics
NPI:1790180107
Name:MARCHIONNA, ANTONELLA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:MARCHIONNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 2153 DEPT 1947
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-0001
Mailing Address - Country:US
Mailing Address - Phone:601-292-4562
Mailing Address - Fax:601-974-6237
Practice Address - Street 1:1887 SPILLWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6066
Practice Address - Country:US
Practice Address - Phone:601-992-5532
Practice Address - Fax:601-992-5547
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily