Provider Demographics
NPI:1548092661
Name:AIME, ADELINE MARCELLUS
Entity type:Individual
Prefix:
First Name:ADELINE
Middle Name:MARCELLUS
Last Name:AIME
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 1:1631 HEATHERMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7252
Mailing Address - Country:US
Mailing Address - Phone:239-878-8642
Mailing Address - Fax:
Practice Address - Street 1:5970 WILLOWS BRIDGE LOOP
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-5217
Practice Address - Country:US
Practice Address - Phone:239-878-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner