Provider Demographics
NPI:1184705295
Name:ABRAHAMSEN, NANCY M (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:ABRAHAMSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 37TH AVENUE NORTH
Mailing Address - Street 2:PMB 365
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 37TH AVENUE NORTH
Practice Address - Street 2:PMB 365
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1416
Practice Address - Country:US
Practice Address - Phone:727-895-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME474742085R0202X
AZ320232085R0202X
DEC-100059072085R0202X
GA0533262085R0202X
MDD479222085R0202X
ME0141572085R0202X
PAMD025965E2085R0202X
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57525Medicare UPIN