Provider Demographics
NPI:1972373462
Name:MCKINNON, ABAGAIL (FNP)
Entity type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:
Last Name:MCKINNON
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:PO BOX 941455
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1455
Mailing Address - Country:US
Mailing Address - Phone:407-573-5733
Mailing Address - Fax:407-573-5491
Practice Address - Street 1:187 S. BOYD ST.
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3574
Practice Address - Country:US
Practice Address - Phone:407-573-5733
Practice Address - Fax:407-573-5491
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12230599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily