Healthcare Provider Details

I. General information

NPI: 1649038472
Provider Name (Legal Business Name): AB TELEMEDICINE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MOUNT ROYAL AVE STE 110D
MARLBOROUGH MA
01752-1992
US

IV. Provider business mailing address

320 GOLD AVE SW STE 620
ALBUQUERQUE NM
87102-3210
US

V. Phone/Fax

Practice location:
  • Phone: 505-738-6388
  • Fax: 505-738-4146
Mailing address:
  • Phone: 505-738-6388
  • Fax: 505-738-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. TAMMY LYNN JONES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 877-317-8812