Healthcare Provider Details

I. General information

NPI: 1508738691
Provider Name (Legal Business Name): KAYLA NICOLE ROBERTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 CROSS COUNTRY BLVD
MARIANNA FL
32446-2511
US

IV. Provider business mailing address

6016 CROSS COUNTRY BLVD
MARIANNA FL
32446-2511
US

V. Phone/Fax

Practice location:
  • Phone: 850-693-8693
  • Fax:
Mailing address:
  • Phone: 850-693-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-002701
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11041231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: