Provider Demographics
NPI:1952569303
Name:CAIN, ROBERT NMN JR (PA,PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NMN
Last Name:CAIN
Suffix:JR
Gender:M
Credentials:PA,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 GLORIETA DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-7489
Mailing Address - Country:US
Mailing Address - Phone:619-871-3252
Mailing Address - Fax:
Practice Address - Street 1:6015 118TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3703
Practice Address - Country:US
Practice Address - Phone:904-633-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA911169363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant