Provider Demographics
NPI:1508521410
Name:MACEDA, JOSE ANTONIO II (NP-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:MACEDA
Suffix:II
Gender:M
Credentials:NP-C
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:ANTONIO
Other - Last Name:MACEDA
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:925 NE 30TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7614
Mailing Address - Country:US
Mailing Address - Phone:305-248-9488
Mailing Address - Fax:
Practice Address - Street 1:925 NE 30TH TER STE 210
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-248-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program