Provider Demographics
NPI:1396720389
Name:WHITE, ROBERT W (PA - C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6098
Mailing Address - Country:US
Mailing Address - Phone:407-573-3360
Mailing Address - Fax:407-643-2811
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 206
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:407-573-3360
Practice Address - Fax:407-643-2811
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA102552363AM0700X
FLPA9102552363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291851000Medicaid
Q15204Medicare UPIN
FL291851000Medicaid