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NPI Code Detail

MEDICARE: ROBINSON J OMOTOLA CRNA

MEDICARE: ROBINSON J OMOTOLA CRNA
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
1367500000XCertified Registered Nurse AnesthetistARNP2030632FL
2367500000XCertified Registered Nurse AnesthetistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G2971OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1760593131
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBINSON J OMOTOLA CRNA
Provider Business Mailing Address
First Line : PO BOX 917756
Second Line :
City : ORLANDO
State : FL
Zip : 32891-7756
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Provider Business Practice Location Address
First Line : 400 N PLEASANT AVE
Second Line :
City : CENTRALIA
State : IL
Zip : 62801-3056
Country : US
Telephone Number : 618-436-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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