Provider Demographics
NPI:1134557796
Name:ROBERTSON, MARIE CAROLINE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARIE CAROLINE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:SEIGNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5707- N. 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-239-8069
Mailing Address - Fax:813-231-7324
Practice Address - Street 1:5707- N. 22ND STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4350
Practice Address - Country:US
Practice Address - Phone:813-239-8069
Practice Address - Fax:813-231-7324
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9329726364SP0809X, 363L00000X
FLAPRN9329726364SP0809X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012391800Medicaid
FLHT019YOtherPTAN