Provider Demographics
NPI:1174733828
Name:CANTAVE, NADINE (ARNP)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:CANTAVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 BARNWELL DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-9258
Mailing Address - Country:US
Mailing Address - Phone:305-388-1484
Mailing Address - Fax:
Practice Address - Street 1:2010 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2058
Practice Address - Country:US
Practice Address - Phone:305-388-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1062049363LF0000X
FL9162862363LF0000X
SC22589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9162862OtherARNP LICENSE
FLAI845YMedicare PIN