Provider Demographics
NPI:1326402819
Name:ROBERTS, KEVIN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36800 QUEEN BEE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-8950
Mailing Address - Country:US
Mailing Address - Phone:352-504-8172
Mailing Address - Fax:
Practice Address - Street 1:36800 QUEEN BEE LN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-8950
Practice Address - Country:US
Practice Address - Phone:352-504-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9325317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily