Provider Demographics
NPI:1821234790
Name:ACEBAL, JOSE ANTONIO (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:ACEBAL
Suffix:
Gender:M
Credentials:ARNP
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Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-557-4016
Practice Address - Fax:305-828-0670
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2022-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9248764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBF719ZMedicare PIN