Provider Demographics
NPI:1467003111
Name:ROBERTSON, ASHA JAMILIA
Entity Type:Individual
Prefix:MS
First Name:ASHA
Middle Name:JAMILIA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 RITA KAY LN LOT #21
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119
Mailing Address - Country:US
Mailing Address - Phone:817-347-0551
Mailing Address - Fax:
Practice Address - Street 1:5321 RITA KAY LN LOT #21
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119
Practice Address - Country:US
Practice Address - Phone:817-347-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider