Healthcare Provider Details

I. General information

NPI: 1801687850
Provider Name (Legal Business Name): STELLA ABIEDU ABAABA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NA NA NA NA

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

10008 RANDALLSTOWN LN
JACKSONVILLE FL
32256-1492
US

V. Phone/Fax

Practice location:
  • Phone: 424-731-3115
  • Fax:
Mailing address:
  • Phone: 424-731-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70019039-NP
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number323625
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: