Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Therese A Ibrahim, MD

Individual provider Family Medicine Physician · NPI 1063514172

Dr. Therese A Ibrahim, MD is a Family Practice in Ormond Beach, Florida. Qualified in 1992, 34 years ago. Practices with Conviva Medical Center Management, LLC, a 562-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
34
Licensed in
FL
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

420 S Nova Rd Ste 4&5
Ormond Beach, FL 32174-0410
Phone: (386) 615-8122
Fax: (844) 899-3686
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence ME94322 (FL)

Record details

NPI number1063514172
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 1, 2006
Last updated in NPPESFebruary 17, 2026
Certification dateFebruary 17, 2026
Mailing address6101 Blue Lagoon Dr Ste 200, Miami, FL 33126-3168

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 1992 (34 years in practice)
Group practice Conviva Medical Center Management, Llc — 562 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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