Provider Demographics
NPI:1184336869
Name:ABASS, FAWAZ HAROON (APRN, AGNP-C)
Entity type:Individual
Prefix:
First Name:FAWAZ
Middle Name:HAROON
Last Name:ABASS
Suffix:
Gender:M
Credentials:APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12486 STONE BARK TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-7373
Mailing Address - Country:US
Mailing Address - Phone:407-271-1355
Mailing Address - Fax:
Practice Address - Street 1:1613 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1849
Practice Address - Country:US
Practice Address - Phone:407-894-4474
Practice Address - Fax:407-894-7136
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023458363L00000X
FLAPRN11023458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner