Provider Demographics
NPI:1063699411
Name:HARTY, ROBIN (ARNP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:HARTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W CONSTANCE RD
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3957
Mailing Address - Country:US
Mailing Address - Phone:386-668-8135
Mailing Address - Fax:386-668-8519
Practice Address - Street 1:260 W CONSTANCE RD
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3957
Practice Address - Country:US
Practice Address - Phone:386-668-8135
Practice Address - Fax:386-668-8519
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3287312163WR0006X
FL3287312363LG0600X
FLARNP3287312363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology