Provider Demographics
NPI:1851931000
Name:PETIT, ROBIN L (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:PETIT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:TEMPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:602 YORK CIR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9064
Mailing Address - Country:US
Mailing Address - Phone:765-215-1139
Mailing Address - Fax:
Practice Address - Street 1:6925 S HARDING ST STE B-1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4114
Practice Address - Country:US
Practice Address - Phone:317-497-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28120871A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily