Provider Demographics
NPI:1013131119
Name:JABBOUR, ALBERT KENNETH (PA)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:KENNETH
Last Name:JABBOUR
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Gender:
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-798-7179
Practice Address - Street 1:9500 BONITA BEACH RD SE STE 100
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4698
Practice Address - Country:US
Practice Address - Phone:239-498-9294
Practice Address - Fax:239-798-7179
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117096363AM0700X
WV516363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical