Provider Demographics
NPI:1093151136
Name:ROBB, JENNIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OFFICE PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1585
Mailing Address - Country:US
Mailing Address - Phone:513-690-2078
Mailing Address - Fax:513-880-0540
Practice Address - Street 1:10 OFFICE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1585
Practice Address - Country:US
Practice Address - Phone:513-690-2078
Practice Address - Fax:513-880-0540
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28172208A163W00000X
OHRN.420665-1163W00000X
VA0001309564163W00000X
IN71004540A363L00000X
VA0024183897363LF0000X
OHCOA.18402-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201183290Medicaid
IN000000829255OtherANTHEM PROVIDER NUMBER
IN201183290Medicaid
IN000000829255OtherANTHEM PROVIDER NUMBER