Provider Demographics
NPI:1336131945
Name:ROBB, JENNIE LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LYNNE
Last Name:ROBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 58TH DRIVE EAST #102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-320-6320
Mailing Address - Fax:941-753-5969
Practice Address - Street 1:9070 58TH DRIVE EAST #102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-320-6320
Practice Address - Fax:941-753-5969
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66722Medicare UPIN