Provider Demographics
NPI:1710730585
Name:PHILLIPS, ROBBIE
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13759 WATERHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8351
Mailing Address - Country:US
Mailing Address - Phone:513-910-8922
Mailing Address - Fax:
Practice Address - Street 1:108 W CITRUS ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-2502
Practice Address - Country:US
Practice Address - Phone:321-972-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2024005877363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health