Provider Demographics
NPI:1104523000
Name:COOKS, ANTRANETTE (APRN)
Entity type:Individual
Prefix:
First Name:ANTRANETTE
Middle Name:
Last Name:COOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BOWSPRIT AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-9485
Mailing Address - Country:US
Mailing Address - Phone:321-501-6125
Mailing Address - Fax:
Practice Address - Street 1:490 CENTRE LAKE DR NE STE 200
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1189
Practice Address - Country:US
Practice Address - Phone:321-821-4950
Practice Address - Fax:321-821-4955
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024510208VP0000X
FL11024510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202248493Medicaid