Healthcare Provider Details

I. General information

NPI: 1932584711
Provider Name (Legal Business Name): ROBERT BELCON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N SUITE 650
CLEARWATER FL
33764-3528
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-8500
  • Fax:
Mailing address:
  • Phone: 727-506-3600
  • Fax: 727-474-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9313063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: