Provider Demographics
NPI:1215413174
Name:EATON, ROBERT LAYNE (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAYNE
Last Name:EATON
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 ORION PATH
Mailing Address - Street 2:
Mailing Address - City:CHUNCHULA
Mailing Address - State:AL
Mailing Address - Zip Code:36521-6249
Mailing Address - Country:US
Mailing Address - Phone:251-454-2623
Mailing Address - Fax:
Practice Address - Street 1:3295 ORION PATH
Practice Address - Street 2:
Practice Address - City:CHUNCHULA
Practice Address - State:AL
Practice Address - Zip Code:36521-6249
Practice Address - Country:US
Practice Address - Phone:251-454-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9483320363LA2100X
MS902545363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care