Basic Information
Provider Information
NPI: 1205347705
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRIMINO ESPINOSA
FirstName: ABEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 121 S ORANGE AVE STE 940
Address2:  
City: ORLANDO
State: FL
PostalCode: 328013234
CountryCode: US
TelephoneNumber: 4076589687
FaxNumber: 4072864515
Practice Location
Address1: 910 W VINE ST
Address2:  
City: KISSIMMEE
State: FL
PostalCode: 347414165
CountryCode: US
TelephoneNumber: 4079561920
FaxNumber: 4074835844
Other Information
ProviderEnumerationDate: 10/24/2017
LastUpdateDate: 12/06/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X9372130FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
120534770501FLNPIOTHER


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