Provider Demographics
NPI:1669677498
Name:CHILDRESS-RODRIGUEZ, ROBIN RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:RENEE
Last Name:CHILDRESS-RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:RENEE
Other - Last Name:CHILDRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:230 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3503
Mailing Address - Country:US
Mailing Address - Phone:831-373-6160
Mailing Address - Fax:831-372-9320
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:STE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1264
Practice Address - Country:US
Practice Address - Phone:770-459-0620
Practice Address - Fax:770-456-7604
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily