=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508530742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AEI CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2021
-----------------------------------------------------
Last Update Date | 06/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2540 W EXECUTIVE CENTER CIRCLE, SUITE 100 DPT# 25031
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-567-9499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2540 W EXECUTIVE CENTER CIRCLE, SUITE 100 DPT# 25031
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32301-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-962-2503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTONIO ABREU JR.
-----------------------------------------------------
Credential | DNP, APRN
-----------------------------------------------------
Telephone | 800-962-2503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------