Doctor Name: | ANTOINETTE DENISE PALOMINO |
NPI Number: | 1174916621 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | RN202063NP |
Business Practice Address: | 4905 Courtney Dr Forest Park, GA - 302971427 |
Business Phone Number: | 4043663636 |
Business Fax Number: | 4043620808 |
Mailing Address: | 4905 Courtney Dr, FOREST PARK |
State: | GA |
Postal Code: | 302971427 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/09/2015 |
NPI Last Update Date: | 03/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN202063NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |