Provider Demographics
NPI:1013980655
Name:ETIENNE, ANNEMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:
Last Name:ETIENNE
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 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:350 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2733
Practice Address - Country:US
Practice Address - Phone:386-676-7103
Practice Address - Fax:386-676-7186
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86041207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013980655OtherTRICARE
FL9032053OtherCIGNA
FL7237323OtherAETNA
FL272646700Medicaid
FL1013980655OtherVHN
FLP00230246OtherRAILROAD
FL1013980655OtherMULTIPLAN
FL13215OtherBCBS
FL1013980655OtherVHN