MEDICARE: DR. JENNIE LYNNE ROBB PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY6351	FL

General Provider Information

NPI Number	:	1336131945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIE LYNNE ROBB PH.D.

Provider Business Mailing Address
First Line	:	9070 58TH DRIVE EAST #102
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202
Country	:	US
Telephone Number	:	941-320-6320
Fax Number	:	941-753-5969

Provider Business Practice Location Address
First Line	:	9070 58TH DRIVE EAST #102
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202
Country	:	US
Telephone Number	:	941-320-6320
Fax Number	:	941-753-5969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/09/2010

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