Healthcare Provider Details

I. General information

NPI: 1891676136
Provider Name (Legal Business Name): ABIGAIL FLORES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COLUMBIA ST STE 201
ORLANDO FL
32806-1133
US

IV. Provider business mailing address

21 COLUMBIA ST STE 201
ORLANDO FL
32806-1133
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6600
  • Fax: 321-841-1827
Mailing address:
  • Phone: 321-841-6600
  • Fax: 321-841-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2024022640
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: