Healthcare Provider Details

I. General information

NPI: 1295376101
Provider Name (Legal Business Name): ROBERT DANIEL NEWCOMB APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

13067 TELECOM PARKWAY N.
TAMPA FL
33637
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3170
  • Fax:
Mailing address:
  • Phone: 813-779-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61622226
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number202207183NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2019038218
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11008204
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number81458
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: