Basic Information
Provider Information | |||||||||
NPI: | 1710932447 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANTOINE | ||||||||
FirstName: | VERONICA | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MITCHELL | ||||||||
OtherFirstName: | VERONICA | ||||||||
OtherMiddleName: | D. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7855 ARGYLE FOREST BLVD | ||||||||
Address2: | STE 101 | ||||||||
City: | JACKSONVILLE | ||||||||
State: | FL | ||||||||
PostalCode: | 322445597 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9049550562 | ||||||||
FaxNumber: | 9042121351 | ||||||||
Practice Location | |||||||||
Address1: | 1361 13TH AVE S | ||||||||
Address2: |   | ||||||||
City: | JACKSONVILLE BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 322503233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9042657755 | ||||||||
FaxNumber: | 9042657754 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2006 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MD-13021 | HI | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | ME134179 | FL | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 0000258830 | 01 | HI | HMSA BILLING NUMBER | OTHER | 022954100 | 05 | FL |   | MEDICAID | JE762Z | 01 | FL | MEDICARE FL | OTHER |