Provider Demographics
NPI:1285460444
Name:ANTONINI, SOPHIA ANASTASIA (DC)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:ANASTASIA
Last Name:ANTONINI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 SAINT JOHNS BLUFF RD S STE 2A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2654
Mailing Address - Country:US
Mailing Address - Phone:904-201-9397
Mailing Address - Fax:
Practice Address - Street 1:3545 SAINT JOHNS BLUFF RD S STE 2A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2654
Practice Address - Country:US
Practice Address - Phone:904-201-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor