Provider Demographics
NPI:1548764111
Name:ROBERTSON, JANE ADAIR CAMACHO (MBA, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JANE ADAIR
Middle Name:CAMACHO
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MBA, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ROSEMONT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3731
Mailing Address - Country:US
Mailing Address - Phone:912-657-0281
Mailing Address - Fax:
Practice Address - Street 1:4750 WATERS AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6268
Practice Address - Country:US
Practice Address - Phone:912-350-5970
Practice Address - Fax:912-350-3374
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235869363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily