Provider Demographics
NPI:1124476585
Name:FLORIDA MOBILE PHYSICIANS,LLC
Entity type:Organization
Organization Name:FLORIDA MOBILE PHYSICIANS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LALANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-907-1190
Mailing Address - Street 1:7313 INTERNATIONAL PL STE 80
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8406
Mailing Address - Country:US
Mailing Address - Phone:941-907-1190
Mailing Address - Fax:
Practice Address - Street 1:7313 INTERNATIONAL PL STE 80
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8406
Practice Address - Country:US
Practice Address - Phone:941-907-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2858852310400000X
FLARNP28588523104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093113086OtherNPI
IB626AOtherPTAN/MEDICARE NUMBER