Provider Demographics
NPI:1033400122
Name:OTERO, ROBERT ANTHONY (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:OTERO
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 EAGLE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3160
Mailing Address - Country:US
Mailing Address - Phone:407-201-2680
Mailing Address - Fax:407-201-2680
Practice Address - Street 1:3098 EAGLE CROSSING DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3160
Practice Address - Country:US
Practice Address - Phone:407-201-2680
Practice Address - Fax:407-201-2680
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3317762363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3317762OtherARNP LICENSE NUMBER
FLARNP3317762OtherARNP LICENSE NUMBER