Provider Demographics
NPI:1780980797
Name:ANTENUCCI, DONNA (LPN, IBCLC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ANTENUCCI
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4548
Mailing Address - Country:US
Mailing Address - Phone:407-325-7926
Mailing Address - Fax:
Practice Address - Street 1:1464 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4548
Practice Address - Country:US
Practice Address - Phone:407-325-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5154846164W00000X
FL196-13069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No164W00000XNursing Service ProvidersLicensed Practical Nurse