=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275866501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN D HAUSSMANN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2009
-----------------------------------------------------
Last Update Date | 11/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 HARRISON AVE
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32401-2524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-785-3232
-----------------------------------------------------
Fax | 850-747-8648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8700 FRONT BEACH RD #5313
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-4277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-643-7195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | PA9105164
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------