Provider Demographics
NPI:1043862592
Name:ABEL, NICALLINA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICALLINA
Middle Name:MARIE
Last Name:ABEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NICALLINA
Other - Middle Name:MARIE
Other - Last Name:MILILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:339 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7711
Mailing Address - Country:US
Mailing Address - Phone:215-464-4111
Mailing Address - Fax:267-574-8111
Practice Address - Street 1:339 E STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7711
Practice Address - Country:US
Practice Address - Phone:215-464-4111
Practice Address - Fax:267-574-8111
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00525500363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical