Healthcare Provider Details

I. General information

NPI: 1871234021
Provider Name (Legal Business Name): IBRAHIM ZAROUG NABOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5790
US

IV. Provider business mailing address

167 SOLANO CAY CIR
PONTE VEDRA BEACH FL
32082-2245
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5155
  • Fax:
Mailing address:
  • Phone: 865-249-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number175257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: