Healthcare Provider Details

I. General information

NPI: 1952649774
Provider Name (Legal Business Name): JAMIE ROBINSON C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14116 CUSTOMS BLVD
GULFPORT MS
39503-5164
US

IV. Provider business mailing address

1650 CARROL DR
BILOXI MS
39531-4301
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-6300
  • Fax:
Mailing address:
  • Phone: 228-534-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR875395
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: