Provider Demographics
NPI:1093940967
Name:ROBINS, JACQUELYN DENISE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:DENISE
Last Name:ROBINS
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 1:5230 TEAL WAY
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-2789
Mailing Address - Country:US
Mailing Address - Phone:864-642-7672
Mailing Address - Fax:281-573-1539
Practice Address - Street 1:411 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669-1322
Practice Address - Country:US
Practice Address - Phone:864-642-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3845367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife