Provider Demographics
NPI:1801888706
Name:ROBOUBI, NAZANIN (DPM)
Entity type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:ROBOUBI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36181 E LAKE RD
Mailing Address - Street 2:SUITE 55
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:727-631-1592
Mailing Address - Fax:727-787-8170
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-631-1592
Practice Address - Fax:727-631-1592
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3060213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU96404Medicare UPIN