Provider Demographics
NPI:1750097465
Name:ABALLE MOSQUEDA, ABEL VICENTE
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:VICENTE
Last Name:ABALLE MOSQUEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27174 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-6058
Mailing Address - Country:US
Mailing Address - Phone:239-200-3878
Mailing Address - Fax:
Practice Address - Street 1:27174 ELAINE DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-6058
Practice Address - Country:US
Practice Address - Phone:239-200-3878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily