Provider Demographics
NPI:1538649033
Name:ABLES, KODRA (RN, OCN)
Entity Type:Individual
Prefix:
First Name:KODRA
Middle Name:
Last Name:ABLES
Suffix:
Gender:F
Credentials:RN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 PINES BLVD STE 415-409
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6455
Mailing Address - Country:US
Mailing Address - Phone:954-272-6103
Mailing Address - Fax:954-637-1888
Practice Address - Street 1:9050 PINES BLVD STE 415-409
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6455
Practice Address - Country:US
Practice Address - Phone:954-272-6103
Practice Address - Fax:954-637-1888
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9338663163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101133500Medicaid