Provider Demographics
NPI:1043035389
Name:ABDEL JABBAR, NIDA S
Entity type:Individual
Prefix:
First Name:NIDA
Middle Name:S
Last Name:ABDEL JABBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28924 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4113
Mailing Address - Country:US
Mailing Address - Phone:786-765-9681
Mailing Address - Fax:
Practice Address - Street 1:28924 SW 163RD AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4113
Practice Address - Country:US
Practice Address - Phone:786-765-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9570315163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics