Healthcare Provider Details

I. General information

NPI: 1689026924
Provider Name (Legal Business Name): ABISOYE SOMORIN DNP, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ORANGE AVE STE 238
DAYTONA BEACH FL
32114-4310
US

IV. Provider business mailing address

128 ORANGE AVE STE 238
DAYTONA BEACH FL
32114-4310
US

V. Phone/Fax

Practice location:
  • Phone: 386-872-8534
  • Fax: 386-204-7309
Mailing address:
  • Phone: 386-872-8534
  • Fax: 386-204-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9355850
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9355850
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9355850
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: