Provider Demographics
NPI:1205820206
Name:ABATE, EDMUND III (PA-C)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:ABATE
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CELEBRATION PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5432
Mailing Address - Country:US
Mailing Address - Phone:407-303-4673
Mailing Address - Fax:407-303-4674
Practice Address - Street 1:410 CELEBRATION PL STE 200
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5432
Practice Address - Country:US
Practice Address - Phone:407-303-4673
Practice Address - Fax:407-303-4674
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101934363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2338YOtherMEDICARE PTAN - QSS SCS
FLHF826AOtherMEDICARE PTAN - GRP QSS SCS
FLHF826AOtherMEDICARE PTAN - GRP QSS SCS
FLHF826AOtherMEDICARE PTAN - GRP QSS SCS
FL291852800Medicaid