Basic Information
| Provider Information | |||||||||
| NPI: | 1578866042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PABON | ||||||||
| FirstName: | ELBA | ||||||||
| MiddleName: | INES | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1095 NW 14TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1095 NW 14TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436946 | ||||||||
| FaxNumber: | 3052433337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2010 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9244962 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APRN9244962 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 003262681002 | 01 | FL | UNITED HEALTHCARE | OTHER | Y06H3 | 01 | FL | BCBS OF FLORIDA | OTHER | 003032400 | 05 | FL | MEDICAID |