Provider Demographics
NPI:1578773917
Name:ABRANTES, CLARISSA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:ROSE
Last Name:ABRANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 COUNTY ROAD 466
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32519-4205
Mailing Address - Country:US
Mailing Address - Phone:352-350-5130
Mailing Address - Fax:352-350-1684
Practice Address - Street 1:871 COUNTY ROAD 466
Practice Address - Street 2:SUITE 200
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4205
Practice Address - Country:US
Practice Address - Phone:352-350-5130
Practice Address - Fax:352-350-1684
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99375207R00000X
MI4301083380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
17923OtherBCBS
17923OtherBCBS