Provider Demographics
NPI:1548654916
Name:ABCEDE, EMILY A (ARNP, CPNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:ABCEDE
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, CPNP
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5003
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5855
Practice Address - Fax:858-966-7903
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007801363LP0200X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015382700Medicaid
FLIH114ZMedicare PIN