Provider Demographics
NPI:1235780537
Name:ABELOW, NICOLLE A
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:A
Last Name:ABELOW
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 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-6775
Mailing Address - Fax:
Practice Address - Street 1:11178 STATE ROAD 54 STE A
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-2266
Practice Address - Country:US
Practice Address - Phone:727-372-4200
Practice Address - Fax:727-333-6371
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004137363L00000X
CA95032302363LF0000X
DELG-0012953363LF0000X
GAGAA-NP002744363LF0000X
MI4704419626363LF0000X
MN12081363LF0000X
MO2024036920363LF0000X
MS906963363LF0000X
NE115636363LF0000X
NH112472-23363LF0000X
NV882352363LF0000X
OR10031127363LF0000X
PASP031773363LF0000X
TX1177677363LF0000X
FLAPRN1104137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty