Healthcare Provider Details

I. General information

NPI: 1871704148
Provider Name (Legal Business Name): ROBYN ELIZABETH BERRYMAN NNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5411
US

IV. Provider business mailing address

4534 ATTLEBORO ST
JACKSONVILLE FL
32205-5037
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-6634
  • Fax:
Mailing address:
  • Phone: 303-549-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number95003206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: