Healthcare Provider Details

I. General information

NPI: 1609059153
Provider Name (Legal Business Name): ABIGAIL HOBBS FAERBER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 SIERRA LN
PUNTA GORDA FL
33950-5016
US

IV. Provider business mailing address

2411 SIERRA LN
PUNTA GORDA FL
33950-5016
US

V. Phone/Fax

Practice location:
  • Phone: 941-637-6605
  • Fax: 941-637-6605
Mailing address:
  • Phone: 941-637-6605
  • Fax: 941-637-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: