Provider Demographics
NPI:1730766817
Name:PAUL, ANTOINETTE PERRY (FNP-C)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:PERRY
Last Name:PAUL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4556 RANDOLPH RD APT 96
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2933
Mailing Address - Country:US
Mailing Address - Phone:704-497-5337
Mailing Address - Fax:
Practice Address - Street 1:4556 RANDOLPH RD APT 96
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2933
Practice Address - Country:US
Practice Address - Phone:704-467-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily