Healthcare Provider Details

I. General information

NPI: 1760113096
Provider Name (Legal Business Name): NURA ABUJBARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 BRANCHTON CHURCH RD
THONOTOSASSA FL
33592-2211
US

IV. Provider business mailing address

73-4336 KUKULU PL
KAILUA KONA HI
96740-9528
US

V. Phone/Fax

Practice location:
  • Phone: 813-693-0227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13010
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: