Provider Demographics
NPI:1023197613
Name:CRUM, ROBIN LEE (CNM)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:CRUM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 N. HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:7800 SHERIDAN STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-962-9650
Practice Address - Fax:954-341-5165
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA185229367A00000X
MSR878113367A00000X
FLAPRN9305336176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA185229OtherLICENSE
MS04871800Medicaid
FLARNP9305336OtherFLORIDA LICENSE
MSR878113OtherMS CNM LICENSE
MSR878113OtherMS CNM LICENSE
GA185229OtherLICENSE