Provider Demographics
NPI:1801622634
Name:ANTOLIN, CLOIE SOPHIA MIRAVITE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CLOIE SOPHIA
Middle Name:MIRAVITE
Last Name:ANTOLIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 E FLAMINGO RD STE 210A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8049
Mailing Address - Country:US
Mailing Address - Phone:323-532-4678
Mailing Address - Fax:
Practice Address - Street 1:1771 E FLAMINGO RD STE 210A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8049
Practice Address - Country:US
Practice Address - Phone:725-243-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV829387363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health