Provider Demographics
NPI:1841045416
Name:ABBA URGENT PRIMARY CARE AND TELEHEALTH
Entity type:Organization
Organization Name:ABBA URGENT PRIMARY CARE AND TELEHEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ITAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:407-446-1922
Mailing Address - Street 1:7601 DEBEAUBIEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8127
Mailing Address - Country:US
Mailing Address - Phone:407-446-1922
Mailing Address - Fax:407-604-4430
Practice Address - Street 1:7601 DEBEAUBIEN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8127
Practice Address - Country:US
Practice Address - Phone:407-446-1922
Practice Address - Fax:407-604-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty