Provider Demographics
NPI:1851867022
Name:ANTOINE, FLORCIE FANELLE
Entity Type:Individual
Prefix:
First Name:FLORCIE
Middle Name:FANELLE
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 E 107TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3014
Mailing Address - Country:US
Mailing Address - Phone:347-570-3106
Mailing Address - Fax:347-570-3106
Practice Address - Street 1:962 E 107TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3014
Practice Address - Country:US
Practice Address - Phone:347-570-3106
Practice Address - Fax:347-570-3106
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299462OtherLICENSE PRACTICAL NURSE