Healthcare Provider Details

I. General information

NPI: 1639922099
Provider Name (Legal Business Name): MAYKEL MORENO ABREU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W ALEXANDER ST
PLANT CITY FL
33563-7136
US

IV. Provider business mailing address

507 W ALEXANDER ST
PLANT CITY FL
33563-7136
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-3504
  • Fax: 813-752-6863
Mailing address:
  • Phone: 813-754-3504
  • Fax: 813-752-6863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11032353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: