NPI 1477484764 · live from the CMS NPI Registry
Abundant Life Healthcare, PLLC
Physician Assistant in Jacksonville, FL. National Provider Identifier 1477484764, active.
NPI record
| NPI | 1477484764 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 841 Prudential Dr Ste 1219a, Jacksonville, FL 32207 |
| Practice phone | 239-273-5588 |
| Mailing address | 1032 E Brandon Blvd # 1769, Brandon, FL 33511 |
| Enumerated | May 26, 2026 |
| Last updated | May 26, 2026 |
| Authorized official | Gabriela Harrison, Manager |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | — |
| Physician Assistant primary | 363A00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.