Healthcare Provider Details

I. General information

NPI: 1326402819
Provider Name (Legal Business Name): KEVIN ROBERTS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36800 QUEEN BEE LN
GRAND ISLAND FL
32735-8950
US

IV. Provider business mailing address

36800 QUEEN BEE LN
GRAND ISLAND FL
32735-8950
US

V. Phone/Fax

Practice location:
  • Phone: 352-504-8172
  • Fax:
Mailing address:
  • Phone: 352-504-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9325317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: