Provider Demographics
NPI:1942203336
Name:JACOBSON, ROBYN WAINBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:WAINBERG
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-286-8835
Practice Address - Street 1:2506 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6326
Practice Address - Country:US
Practice Address - Phone:813-870-3720
Practice Address - Fax:813-877-2484
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256441600Medicaid
FL47297ZMedicare PIN
FLG99362Medicare UPIN