Provider Demographics
NPI:1194143115
Name:ABRAHAN, DENNRIK (MD)
Entity type:Individual
Prefix:
First Name:DENNRIK
Middle Name:
Last Name:ABRAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 DR MARTIN LUTHER KING ST N STE 108
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1547
Mailing Address - Country:US
Mailing Address - Phone:727-865-4290
Mailing Address - Fax:727-346-1054
Practice Address - Street 1:17 DAVIS BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3475
Practice Address - Country:US
Practice Address - Phone:813-250-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1444492080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB44B7OtherBLUE CROSS BLUE SHIELD
FL106524700Medicaid