Provider Demographics
NPI:1922692169
Name:ANTOINE, MARIE JOSE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIE JOSE
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIE JOSE
Other - Middle Name:P
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN/APRN/FNP-C
Mailing Address - Street 1:1018 RIVER FOREST PT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2600
Mailing Address - Country:US
Mailing Address - Phone:194-123-7817
Mailing Address - Fax:
Practice Address - Street 1:1018 RIVER FOREST PT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2600
Practice Address - Country:US
Practice Address - Phone:941-237-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily