MEDICARE: ROBERT RAYMOND NEBUS

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	164W00000X	Licensed Practical Nurse	PN5255057	FL

General Provider Information

NPI Number	:	1982538898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RAYMOND NEBUS

Provider Business Mailing Address
First Line	:	1212 NW 30TH AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4446 E FLETCHER AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4942
Country	:	US
Telephone Number	:	813-971-6700
Fax Number	:	813-977-1352

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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