Provider Demographics
NPI:1699985861
Name:ANTONIC, NEBOJSA
Entity type:Individual
Prefix:MR
First Name:NEBOJSA
Middle Name:
Last Name:ANTONIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 SUNSET POINT RD APT 2502
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1236
Mailing Address - Country:US
Mailing Address - Phone:727-738-0201
Mailing Address - Fax:
Practice Address - Street 1:1379 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6246
Practice Address - Country:US
Practice Address - Phone:727-738-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist