Provider Demographics
NPI:1336659242
Name:RAY, ABIGAIL MARJORIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARJORIE
Last Name:RAY
Suffix:
Gender:F
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 1:15821 HOLLYFERN CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3732
Mailing Address - Country:US
Mailing Address - Phone:239-432-5100
Mailing Address - Fax:239-432-0629
Practice Address - Street 1:15821 HOLLYFERN CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3732
Practice Address - Country:US
Practice Address - Phone:239-432-5100
Practice Address - Fax:239-432-0629
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty