Provider Demographics
NPI:1073162301
Name:BOIRE, ROBERT WILFRED
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILFRED
Last Name:BOIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OSPREY LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4681
Mailing Address - Country:US
Mailing Address - Phone:863-937-2999
Mailing Address - Fax:
Practice Address - Street 1:515 OSPREY LANDING DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4681
Practice Address - Country:US
Practice Address - Phone:863-937-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA284066376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide