Individual
JASON SCOTT ABRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3030 HARDEN BLVD, LAKELAND, FL 33803-7952
(863) 687-1250
(863) 687-1258
Mailing address
7955 SPYGLASS HILL RD, STE A, MELBOURNE, FL 32940-8249
(321) 751-3389
(321) 242-2545
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112718
FL
363AS0400X
Surgical Physician Assistant
PA9112718
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111039100
—
FL
Enumeration date
04/29/2019
Last updated
02/21/2024
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