Provider Demographics
NPI:1275173288
Name:ABBONDOLO, JACQUELINE ANNA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNA
Last Name:ABBONDOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22909 SW MARINE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3252
Mailing Address - Country:US
Mailing Address - Phone:352-547-0527
Mailing Address - Fax:
Practice Address - Street 1:22909 SW MARINE BLVD
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-3252
Practice Address - Country:US
Practice Address - Phone:352-547-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)