Provider Demographics
NPI:1598263162
Name:FREIRE, ANTONIO MARIA (PA)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MARIA
Last Name:FREIRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268704
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-8704
Mailing Address - Country:US
Mailing Address - Phone:954-217-0158
Mailing Address - Fax:954-217-0158
Practice Address - Street 1:1150 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5031
Practice Address - Country:US
Practice Address - Phone:954-616-2020
Practice Address - Fax:954-616-3030
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006400363LF0000X
FL9110866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily