Provider Demographics
NPI:1689300576
Name:ROBINSON, SOPHONIE
Entity Type:Individual
Prefix:
First Name:SOPHONIE
Middle Name:
Last Name:ROBINSON
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 1:30 WOODLAND AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2886
Mailing Address - Country:US
Mailing Address - Phone:321-613-2004
Mailing Address - Fax:321-613-2031
Practice Address - Street 1:30 WOODLAND AVENUE
Practice Address - Street 2:STE A
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2886
Practice Address - Country:US
Practice Address - Phone:321-613-2004
Practice Address - Fax:321-613-2031
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9407537163W00000X
FLAPRN11028874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse