MEDICARE: CAI HEALTH & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist

General Provider Information

NPI Number	:	1518694389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAI HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	2095 CLUB LAKE DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-2648
Country	:	US
Telephone Number	:	305-335-7131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 CLUB LAKE DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-2648
Country	:	US
Telephone Number	:	305-335-7131
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	CECILIA IFEOMA IBE
Credential	:	APRN
Telephone Number	:	305-335-7131

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “CAI HEALTH & WELLNESS LLC ” Practice Location

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