Provider Demographics
NPI:1386486884
Name:ANTONIO, LORAYNE (FNP-C)
Entity type:Individual
Prefix:
First Name:LORAYNE
Middle Name:
Last Name:ANTONIO
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 1:396 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3832
Mailing Address - Country:US
Mailing Address - Phone:857-701-7011
Mailing Address - Fax:
Practice Address - Street 1:396 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3832
Practice Address - Country:US
Practice Address - Phone:857-701-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily