Provider Demographics
NPI:1720256340
Name:ROBELIN, PHILIPPE (PA)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:ROBELIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 OAKLEY SEAVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1968
Mailing Address - Country:US
Mailing Address - Phone:877-876-3627
Mailing Address - Fax:321-843-4101
Practice Address - Street 1:865 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:877-876-3627
Practice Address - Fax:321-843-4101
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101725363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014059800Medicaid
FLAJ176ZMedicare PIN
FLAJ176WMedicare PIN