Provider Demographics
NPI:1841845799
Name:STARK, ROBIN M (MSN, APRN, FNP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:STARK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1840
Mailing Address - Country:US
Mailing Address - Phone:315-464-2929
Mailing Address - Fax:
Practice Address - Street 1:1000 E GENESEE ST STE 402
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1853
Practice Address - Country:US
Practice Address - Phone:315-464-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344430-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily