Provider Demographics
NPI:1740554732
Name:ALLEN-GASCO, ROBERT C (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:ALLEN-GASCO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:11241 MIROMAR SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6229
Practice Address - Country:US
Practice Address - Phone:239-992-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005398363LF0000X
SCAPN 17717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2054Medicaid