Provider Demographics
NPI:1790931533
Name:MUNOZ, ROBIN L (CRNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIANNA WAY
Mailing Address - Street 2:MAIL DROP 4840
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72919-9008
Mailing Address - Country:US
Mailing Address - Phone:479-201-4840
Mailing Address - Fax:
Practice Address - Street 1:815 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1141
Practice Address - Country:US
Practice Address - Phone:814-886-2911
Practice Address - Fax:814-886-8929
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167626Medicare PIN