Provider Demographics
NPI:1952312894
Name:SPOTO-CANNONS, ANTOINETTE C (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:C
Last Name:SPOTO-CANNONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:17 DAVIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3468
Practice Address - Country:US
Practice Address - Phone:813-974-2201
Practice Address - Fax:813-974-2812
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256487400Medicaid
FL46741OtherBLUE CROSS BLUE SHIELD
370015266Medicare PIN
FLH05873Medicare UPIN
FL256487400Medicaid