=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174019251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN ANNE LEE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2018
-----------------------------------------------------
Last Update Date | 03/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 MT CLEMENT PARK STE C
-----------------------------------------------------
City | TAPPAHANNOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22560-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-443-6063
-----------------------------------------------------
Fax | 804-443-6005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10401 SPOTSYLVANIA AVE STE 200
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22408-8606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-426-4554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | 0001244755
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024176476
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------