Provider Demographics
NPI:1457738890
Name:ABRAHAM, JESSY SAMUEL
Entity Type:Individual
Prefix:MRS
First Name:JESSY
Middle Name:SAMUEL
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JESSY
Other - Middle Name:SAMUEL
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-405-3722
Practice Address - Street 1:302 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3415
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-738-9001
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226920363LF0000X
FLAPRN9226290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily