Healthcare Provider Details

I. General information

NPI: 1770590366
Provider Name (Legal Business Name): NICHOLE ELLA ROBINSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NATIONAL HEALTH CARE DR
DAYTONA BEACH FL
32114-1495
US

IV. Provider business mailing address

3425 S ATLANTIC AVE APT 1205
DAYTONA BEACH SHORES FL
32118-6366
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax: 386-323-7593
Mailing address:
  • Phone: 386-756-8358
  • Fax: 253-484-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS8135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: