MEDICARE: ROBIN A KELLY CNA

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	376K00000X	Nurse's Aide	119231	FL

General Provider Information

NPI Number	:	1720504293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN A KELLY CNA

Provider Business Mailing Address
First Line	:	7523 PITCH PINE CIR APT B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-8517
Country	:	US
Telephone Number	:	813-562-4174
Fax Number	:

Provider Business Practice Location Address
First Line	:	7523 PITCH PINE CIRCLE
Second Line	:	APT B
City	:	TAMPA
State	:	FL
Zip	:	33617
Country	:	US
Telephone Number	:	813-562-4174
Fax Number	:

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

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	07/21/2022

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