Provider Demographics
NPI:1700351384
Name:ALFONSO MACIAS, ALEXEI (APRN)
Entity type:Individual
Prefix:
First Name:ALEXEI
Middle Name:
Last Name:ALFONSO MACIAS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 WOODRUFF DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9192
Mailing Address - Country:US
Mailing Address - Phone:786-780-3159
Mailing Address - Fax:
Practice Address - Street 1:2822 WOODRUFF DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9192
Practice Address - Country:US
Practice Address - Phone:786-780-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM101972-P171M00000X
FL11042100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM101972-PMedicaid