Healthcare Provider Details

I. General information

NPI: 1205606449
Provider Name (Legal Business Name): ROBIN D KOBBERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 JOBETH DR
NEW PRT RCHY FL
34652
US

IV. Provider business mailing address

5336 JOBETH DR
NEW PRT RCHY FL
34652
US

V. Phone/Fax

Practice location:
  • Phone: 971-999-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: