Provider Demographics
NPI:1932405339
Name:ABDEL-MOTELB, AISHA A (FNP)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:A
Last Name:ABDEL-MOTELB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NW NORTH RIVER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2868
Mailing Address - Country:US
Mailing Address - Phone:315-745-0904
Mailing Address - Fax:
Practice Address - Street 1:1480 NW NORTH RIVER DR APT 304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2868
Practice Address - Country:US
Practice Address - Phone:315-745-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302062-1164W00000X
FLAPRN11027859363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse