Basic Information
Provider Information
NPI: 1013341080
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EMMONETTE
FirstName: ANN
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: ARNP, CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 770 NORTHPOINT PKWY STE 100
Address2:  
City: WEST PALM BEACH
State: FL
PostalCode: 334071901
CountryCode: US
TelephoneNumber: 5616553331
FaxNumber: 5616553744
Practice Location
Address1: 770 NORTHPOINT PKWY STE 100
Address2:  
City: WEST PALM BEACH
State: FL
PostalCode: 334071901
CountryCode: US
TelephoneNumber: 5616553331
FaxNumber: 5616553744
Other Information
ProviderEnumerationDate: 08/27/2013
LastUpdateDate: 01/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XARNP-9235388FLY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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