Provider Demographics
NPI:1891402632
Name:ANTA, CLARA LOURDES (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:LOURDES
Last Name:ANTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 SW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5455
Mailing Address - Country:US
Mailing Address - Phone:305-332-4175
Mailing Address - Fax:
Practice Address - Street 1:6830 SW 120TH ST
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5455
Practice Address - Country:US
Practice Address - Phone:305-332-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner