Provider Demographics
NPI:1669149589
Name:FELIX, ROBOAM
Entity type:Individual
Prefix:
First Name:ROBOAM
Middle Name:
Last Name:FELIX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-4240
Mailing Address - Country:US
Mailing Address - Phone:202-534-2534
Mailing Address - Fax:407-513-9601
Practice Address - Street 1:3303 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-4240
Practice Address - Country:US
Practice Address - Phone:202-534-2534
Practice Address - Fax:407-513-9601
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5206619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN5206619OtherVETERANS AFFAIRS