Provider Demographics
NPI:1902290281
Name:VANCE, XIOMARA ANTONETTI (MD)
Entity Type:Individual
Prefix:DR
First Name:XIOMARA
Middle Name:ANTONETTI
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:XIOMARA
Other - Middle Name:
Other - Last Name:ANTONETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:317 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6338
Mailing Address - Country:US
Mailing Address - Phone:910-577-2345
Mailing Address - Fax:
Practice Address - Street 1:317 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6338
Practice Address - Country:US
Practice Address - Phone:910-577-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293040-1207P00000X
NC2020-00137207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine