Provider Demographics
NPI:1700358991
Name:WHITING, ROBIN ALINE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ALINE
Last Name:WHITING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 MYLA LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-1908
Mailing Address - Country:US
Mailing Address - Phone:321-243-4189
Mailing Address - Fax:321-752-0077
Practice Address - Street 1:2271 MYLA LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-1908
Practice Address - Country:US
Practice Address - Phone:321-243-4189
Practice Address - Fax:321-752-0077
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230485600Medicaid