Provider Demographics
NPI: | 1922643238 |
---|---|
Name: | REED, ABIGAIL CHRISTINE (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | ABIGAIL |
Middle Name: | CHRISTINE |
Last Name: | REED |
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: | 14601 HOPE CENTER LOOP |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT MYERS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33912-4707 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-334-7000 |
Mailing Address - Fax: | 239-334-7070 |
Practice Address - Street 1: | 14601 HOPE CENTER LOOP |
Practice Address - Street 2: | |
Practice Address - City: | FORT MYERS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33912-4707 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-334-7000 |
Practice Address - Fax: | 239-334-7070 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-11-11 |
Last Update Date: | 2023-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PA9112939 | 363A00000X, 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 105377200 | Medicaid |