Provider Demographics
NPI:1790272441
Name:FLORENDO, AMABELLE PICARDO (NP)
Entity Type:Individual
Prefix:MS
First Name:AMABELLE
Middle Name:PICARDO
Last Name:FLORENDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:AMABELLE
Other - Middle Name:REGALA
Other - Last Name:PICARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 W MERCURY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3328
Mailing Address - Country:US
Mailing Address - Phone:757-276-9526
Mailing Address - Fax:877-487-2116
Practice Address - Street 1:1118 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3328
Practice Address - Country:US
Practice Address - Phone:757-276-9526
Practice Address - Fax:877-487-2116
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002292363L00000X, 363LA2100X
VA0024175525363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790272441Medicaid