=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407309867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIS M ROBERTS CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2016
-----------------------------------------------------
Last Update Date | 06/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 DOCTORS DR
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-784-7722
-----------------------------------------------------
Fax | 850-784-6903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 DOCTORS DR
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32405-4559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-784-7722
-----------------------------------------------------
Fax | 850-784-6903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.019739
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 9427616
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------