Provider Demographics
NPI:1376135335
Name:ROBINSON, JASON ULYSSES (FNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ULYSSES
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1848
Mailing Address - Country:US
Mailing Address - Phone:585-752-3858
Mailing Address - Fax:
Practice Address - Street 1:518 JAMES ST STE B60
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-4213
Practice Address - Country:US
Practice Address - Phone:315-423-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily