Provider Demographics
NPI:1265691331
Name:HALL, ROBERT MICHAEL (ARNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:HALL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3820 TAMPA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3609
Mailing Address - Country:US
Mailing Address - Phone:727-785-4540
Mailing Address - Fax:727-773-9716
Practice Address - Street 1:4296 5TH AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2173
Practice Address - Country:US
Practice Address - Phone:850-482-2061
Practice Address - Fax:850-633-5911
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2515702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001258800Medicaid
FLY00ZFOtherBLUE CROSS BLUE SHIELD
FL001258800Medicaid