Healthcare Provider Details

I. General information

NPI: 1154918936
Provider Name (Legal Business Name): AMINA ABOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 BANCROFT PL APT B
PALM HARBOR FL
34683-2403
US

IV. Provider business mailing address

2150 BANCROFT PL APT B
PALM HARBOR FL
34683-2403
US

V. Phone/Fax

Practice location:
  • Phone: 405-889-6596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9550535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: