Provider Demographics
NPI:1609268614
Name:BABA HEALTHCARE
Entity Type:Organization
Organization Name:BABA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTAILING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-956-7370
Mailing Address - Street 1:948 S WICKHAM RD
Mailing Address - Street 2:STE 103
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1647
Mailing Address - Country:US
Mailing Address - Phone:321-956-7370
Mailing Address - Fax:321-956-7873
Practice Address - Street 1:948 S WICKHAM RD
Practice Address - Street 2:STE
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1647
Practice Address - Country:US
Practice Address - Phone:321-956-7370
Practice Address - Fax:321-956-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9179052363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty