Provider Demographics
NPI:1982686689
Name:ABDOU, JEANNE A (APRN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:ABDOU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1304 SE 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3212
Practice Address - Country:US
Practice Address - Phone:239-574-7344
Practice Address - Fax:239-574-7765
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1448402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY06XPOtherFLORIDA BLUE
FLE2875AMedicare ID - Type Unspecified
FLY06XPOtherFLORIDA BLUE