Provider Demographics
NPI:1336626449
Name:PIERCE, ANTOINETTE (RN)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-8414
Mailing Address - Country:US
Mailing Address - Phone:407-399-1827
Mailing Address - Fax:
Practice Address - Street 1:410 EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738
Practice Address - Country:US
Practice Address - Phone:407-399-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9461756163W00000X, 171M00000X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator