Healthcare Provider Details

I. General information

NPI: 1811656440
Provider Name (Legal Business Name): ROBERT KOLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16690 SW CHIPOLA RD
BLOUNTSTOWN FL
32424-1953
US

IV. Provider business mailing address

16690 SW CHIPOLA RD
BLOUNTSTOWN FL
32424-1953
US

V. Phone/Fax

Practice location:
  • Phone: 850-674-4311
  • Fax:
Mailing address:
  • Phone: 850-674-4311
  • Fax: 850-674-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: