Provider Demographics
NPI:1174011050
Name:PHILLIPS, ROBIN DENISE
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:DENISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:DENISE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 SW 69TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3783
Mailing Address - Country:US
Mailing Address - Phone:904-420-9649
Mailing Address - Fax:
Practice Address - Street 1:1965 SW 69TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3783
Practice Address - Country:US
Practice Address - Phone:904-420-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care