=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528689890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOVETA ROBINSON PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2020
-----------------------------------------------------
Last Update Date | 04/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12388 WARWICK BLVD STE 303
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-3857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-528-8371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 MCCRAE DR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-9361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-532-5497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 0024179148
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------