MEDICARE: JANESHIA D ROBINSON FNP-BC

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	363L00000X	Nurse Practitioner	25930	SC
2	163WG0000X	General Practice Registered Nurse	208527	SC

General Provider Information

NPI Number	:	1558963454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANESHIA D ROBINSON FNP-BC

Provider Business Mailing Address
First Line	:	104 DIXIE AVE
Second Line	:
City	:	BRADLEY
State	:	SC
Zip	:	29819-3124
Country	:	US
Telephone Number	:	864-321-9529
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 W MARTINTOWN RD STE 200
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-6104
Country	:	US
Telephone Number	:	803-265-2015
Fax Number	:	803-510-4996

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

Provider Enumeration Date	:	11/15/2020
Last Update Date	:	08/16/2022

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