Provider Demographics
NPI:1700456316
Name:ROBERSON, KARA
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:ROBERSON
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 1:100 TINDALE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4614
Mailing Address - Country:US
Mailing Address - Phone:229-669-0900
Mailing Address - Fax:
Practice Address - Street 1:100 TINDALE CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4614
Practice Address - Country:US
Practice Address - Phone:229-669-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174N00000X, 374J00000X
FLMA74212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist