Provider Demographics
NPI:1578100236
Name:COON, ROBIN DENISE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DENISE
Last Name:COON
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 1:25045 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ASTATULA
Mailing Address - State:FL
Mailing Address - Zip Code:34705-9638
Mailing Address - Country:US
Mailing Address - Phone:352-321-1285
Mailing Address - Fax:
Practice Address - Street 1:25045 ADAMS ST
Practice Address - Street 2:
Practice Address - City:ASTATULA
Practice Address - State:FL
Practice Address - Zip Code:34705-9638
Practice Address - Country:US
Practice Address - Phone:352-321-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW388176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW388OtherFLORIDA LICENSE