Healthcare Provider Details

I. General information

NPI: 1215930334
Provider Name (Legal Business Name): ROBERT ALAN SKOTNICKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441 SUITE 810
THE VILLAGES FL
32159-8975
US

IV. Provider business mailing address

1020 LAKE SUMTER LNDG
THE VILLAGES FL
32162-2699
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-8700
  • Fax: 352-674-8714
Mailing address:
  • Phone: 352-674-8820
  • Fax: 352-674-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS004652L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS13035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: