Provider Demographics
NPI:1205357654
Name:MEKONEN, SEMHAR ABRAHAM (MSN, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:SEMHAR
Middle Name:ABRAHAM
Last Name:MEKONEN
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD BLDG B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2020
Practice Address - Country:US
Practice Address - Phone:727-258-9143
Practice Address - Fax:727-823-7043
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9274983363LP0200X, 363L00000X
FLARNP9274983363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021730600Medicaid