Provider Demographics
NPI:1811289432
Name:ANTONIO, EMMANUEL S (FNP-BC)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:S
Last Name:ANTONIO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 LIMESTONE RD
Mailing Address - Street 2:STE 7
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5553
Mailing Address - Country:US
Mailing Address - Phone:302-355-2383
Mailing Address - Fax:302-351-6261
Practice Address - Street 1:2006 LIMESTONE RD
Practice Address - Street 2:STE 7
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-355-2383
Practice Address - Fax:302-351-6261
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE224057ZCZLMedicare PIN
DE224057YYWMedicare PIN