Healthcare Provider Details

I. General information

NPI: 1477484764
Provider Name (Legal Business Name): ABUNDANT LIFE HEALTHCARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 1219A
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

1032 E BRANDON BLVD # 1769
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 239-273-5588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELA HARRISON
Title or Position: MANAGER
Credential: PA-C
Phone: 239-273-5588