Provider Demographics
NPI:1841584059
Name:ROBINSON, WAVOKA NAGANA (CAREGIVER-AFCH)
Entity type:Individual
Prefix:
First Name:WAVOKA
Middle Name:NAGANA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CAREGIVER-AFCH
Other - Prefix:
Other - First Name:WAVOKA
Other - Middle Name:NAGANA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AREGIVER-AFCH
Mailing Address - Street 1:1289 MAYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32759-9103
Mailing Address - Country:US
Mailing Address - Phone:386-345-2022
Mailing Address - Fax:
Practice Address - Street 1:1289 MAYTOWN RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:FL
Practice Address - Zip Code:32759-9103
Practice Address - Country:US
Practice Address - Phone:386-345-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905280302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization