Healthcare Provider Details

I. General information

NPI: 1073177960
Provider Name (Legal Business Name): DEANNA LYN ROBIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 07/01/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 VIRGINIA BEACH BLVD
VIRGINIA BCH VA
23452-1782
US

IV. Provider business mailing address

811 REDGATE AVE
NORFOLK VA
23507-1515
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4648
  • Fax:
Mailing address:
  • Phone: 757-668-7007
  • Fax: 757-668-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019357
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178715
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: