Provider Demographics
NPI:1639759079
Name:MCNEALY, AUBREY
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 E MCDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3829
Mailing Address - Country:US
Mailing Address - Phone:352-631-1545
Mailing Address - Fax:
Practice Address - Street 1:1365 E MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3829
Practice Address - Country:US
Practice Address - Phone:352-631-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237495376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
237495OtherAHCA LICENSE NUMBER