Space Coast Nephrology Associates, PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

SPACE COAST NEPHROLOGY ASSOCIATES, PLLC

Practice address

111 E Hibiscus Blvd
Melbourne, FL 32901-3102

Phone

(321) 768-3655

Fax

(321) 831-3024

NPI assigned

Jan 25, 2019

Last updated

Aug 2, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tabitha Abraham

Title

Practice Administrator

Phone

(321) 768-3655

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1821552696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013102",
            "telephone_number": "321-768-3655",
            "fax_number": "321-831-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E HIBISCUS BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013102",
            "telephone_number": "321-768-3655",
            "fax_number": "321-831-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST NEPHROLOGY ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "321-768-3655"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Nephrology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.