Healthcare Provider Details

I. General information

NPI: 1992921977
Provider Name (Legal Business Name): ROBERTA K REXROTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 KEYSVILLE AVE
SPRING HILL FL
34608-3515
US

IV. Provider business mailing address

9256 BIRMINGHAM AVE
WEEKI WACHEE FL
34613-4424
US

V. Phone/Fax

Practice location:
  • Phone: 352-666-4216
  • Fax: 352-666-4216
Mailing address:
  • Phone: 352-596-0907
  • Fax: 352-597-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number912712-ARNP
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: