Rae Ann Antonucci, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9105373 Issued in FL

Practice address

122 Nesbit St Ste 112
Punta Gorda, FL 33950-3653

Phone

(941) 347-7707

NPI assigned

Feb 7, 2008

Last updated

Apr 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gulf Shore Aesthetics

  • Health Service Clinic/Center
  • Punta Gorda, FL
  • NPI 1063049435
  NPD Authorized official
• SWFL Scientific Rejuvenation LLC

  • Medical Specialty Clinic/Center
  • Punta Gorda, FL
  • NPI 1023786928
  NPD
• Gulf Coast Emergency Physicians PA

  • Emergency Medicine Physician
  • Port Charlotte, FL
  • NPI 1518989318
  NPD (past)
• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1619155009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 NESBIT ST STE 112",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339503653",
            "telephone_number": "941-347-7707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 NESBIT ST STE 112",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339503653",
            "telephone_number": "941-347-7707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONUCCI",
        "first_name": "RAE ANN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-07",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "574430236A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "Y09FA",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anemone Emergency Physicians, LLC
• Angela Keon MD LLC
• Fabiola Anglade-Pascal, ARNP
• Annette C Romero, PLLC
• Michelle Lea Antanovich, CRNP PMHNP
• Shawn Escar Arkon, APRN
• Whitney Armenio, MS, CCC-SLP
• Estuardo E. Aroca, D.O
• Robert J Aruta, DC, DABCO
• Brandie Arvay

• Medical Physician Assistant in Punta Gorda, FL
• Providers in Punta Gorda, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.