Healthcare Provider Details

I. General information

NPI: 1477258309
Provider Name (Legal Business Name): ROBIN NICOLE GREEN DIRECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 NW 39TH AVE STE 130
GAINESVILLE FL
32606-7366
US

IV. Provider business mailing address

9200 NW 39TH AVE STE 130
GAINESVILLE FL
32606-7366
US

V. Phone/Fax

Practice location:
  • Phone: 267-670-6784
  • Fax:
Mailing address:
  • Phone: 267-670-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number17648-163-075-3517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: