Provider Demographics
NPI:1861683237
Name:PAVEY-MCDANIEL, ANTOINETTE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:PAVEY-MCDANIEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:203 S GLORIA ST
Mailing Address - Street 2:HENDRY REGIONAL CORP HEALTH
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440
Mailing Address - Country:US
Mailing Address - Phone:863-983-1123
Mailing Address - Fax:863-983-1137
Practice Address - Street 1:203 S GLORIA ST
Practice Address - Street 2:HENDRY REGIONAL CORP HEALTH
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440
Practice Address - Country:US
Practice Address - Phone:863-983-1123
Practice Address - Fax:863-983-1137
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1806632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily