Healthcare Provider Details

I. General information

NPI: 1275708141
Provider Name (Legal Business Name): MONICA MARY ABARE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MAIN LN
ORLANDO FL
32801-3727
US

IV. Provider business mailing address

818 MAIN LN
ORLANDO FL
32801-3727
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5212
  • Fax: 321-841-5103
Mailing address:
  • Phone: 321-841-5212
  • Fax: 321-841-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: