Provider Demographics
NPI:1790430569
Name:ANTOINE, JESENIA
Entity Type:Individual
Prefix:
First Name:JESENIA
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESENIA
Other - Middle Name:
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 LARGO CAY CT APT 203
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4825
Mailing Address - Country:US
Mailing Address - Phone:321-326-4849
Mailing Address - Fax:631-327-7191
Practice Address - Street 1:335 LARGO CAY CT APT 203
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4825
Practice Address - Country:US
Practice Address - Phone:321-326-4849
Practice Address - Fax:631-327-7191
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4617251E00000X
FLL21000489589251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health