Provider Demographics
NPI:1003653833
Name:ESPINOSA ABRAHANTE, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:ESPINOSA ABRAHANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HANCOCK BRIDGE PKWY W
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2088
Mailing Address - Country:US
Mailing Address - Phone:239-458-2070
Mailing Address - Fax:
Practice Address - Street 1:100 HANCOCK BRIDGE PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2088
Practice Address - Country:US
Practice Address - Phone:239-458-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist