Healthcare Provider Details

I. General information

NPI: 1386196426
Provider Name (Legal Business Name): GINA PETRACCO-ROBBINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19527 HIGHLAND OAKS DR STE 201
ESTERO FL
33928-9637
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 239-237-0770
  • Fax: 239-237-0771
Mailing address:
  • Phone: 239-313-2517
  • Fax: 239-313-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: