Provider Demographics
NPI:1720504293
Name:KELLY, ROBIN A (CNA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7523 PITCH PINE CIR APT B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8517
Mailing Address - Country:US
Mailing Address - Phone:813-562-4174
Mailing Address - Fax:
Practice Address - Street 1:7523 PITCH PINE CIRCLE
Practice Address - Street 2:APT B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617
Practice Address - Country:US
Practice Address - Phone:813-562-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL119231376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty