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General NPI Number Information
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NPI Number | 1063232346
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Entity Type | Individual
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Provider Name | ABRAHAM BETANCOURT
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1431 SW 1ST AVE
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City | OCALA
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State | FL
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Zip | 34471-6500
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Country | US
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Telephone | 352-401-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3585 SW 38TH TER UNIT O104
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City | OCALA
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State | FL
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Zip | 34474-5834
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Country | US
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Telephone | 786-307-4695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9119359
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License Number State | FL
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