Provider Demographics
NPI:1285724641
Name:FALK, ANTOINETTE M (MD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:M
Last Name:FALK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 LIVE OAK AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3178
Mailing Address - Country:US
Mailing Address - Phone:727-526-6699
Mailing Address - Fax:866-469-3880
Practice Address - Street 1:535 CENTRAL AVE STE 316
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3703
Practice Address - Country:US
Practice Address - Phone:727-526-6699
Practice Address - Fax:866-469-3880
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME589412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12515OtherBLUE SHIELD
FL12515OtherBLUE SHIELD
FL12515Medicare ID - Type Unspecified