Provider Demographics
NPI:1134283807
Name:BRADEN, ROBIN (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BRADEN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:BRADEN
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:PO BOX 907790
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0912
Mailing Address - Country:US
Mailing Address - Phone:770-536-8109
Mailing Address - Fax:770-536-3203
Practice Address - Street 1:2324 LIMESTONE OVERLOOK
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7443
Practice Address - Country:US
Practice Address - Phone:770-536-8109
Practice Address - Fax:770-536-3203
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA459289OtherWELLCARE
GA01213652OtherAMERIGROUP
GA418169008BMedicaid
GA459289OtherWELLCARE
GA511I500475Medicare PIN