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General NPI Number Information
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NPI Number | 1609268614
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Entity Type | Organization
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Legal Business Name | BABA HEALTHCARE
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 948 S WICKHAM RD STE
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City | W MELBOURNE
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State | FL
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Zip | 32904-1647
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Country | US
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Telephone | 321-956-7370
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Fax | 321-956-7873
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Provider Business Mailing Address
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Address Line | 948 S WICKHAM RD STE 103
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City | W MELBOURNE
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State | FL
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Zip | 32904-1647
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Country | US
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Telephone | 321-956-7370
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Fax | 321-956-7873
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Authorized Official
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Title or Position | INSURANCE CREDENTAILING
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Name | MRS. DIANE CAROL ROBERSON
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Credential |
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Telephone | 321-956-7370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | ARNP 9179052
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License Number State | FL
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