Provider Demographics
NPI:1093843948
Name:ABISLAIMAN, ELOISA CRISTIAN (ARNP)
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:CRISTIAN
Last Name:ABISLAIMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16366 ASHINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2639
Mailing Address - Country:US
Mailing Address - Phone:813-459-0926
Mailing Address - Fax:813-388-4567
Practice Address - Street 1:16554 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1325
Practice Address - Country:US
Practice Address - Phone:813-631-1010
Practice Address - Fax:813-971-1804
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1642602363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBE846ZMedicare PIN