Provider Demographics
NPI:1194445353
Name:ROBINSON, ADDRIENNE FAITH (NP)
Entity type:Individual
Prefix:MRS
First Name:ADDRIENNE
Middle Name:FAITH
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 MCPHAIL ST
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-8756
Mailing Address - Country:US
Mailing Address - Phone:803-968-4643
Mailing Address - Fax:
Practice Address - Street 1:213 TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-7100
Practice Address - Country:US
Practice Address - Phone:803-337-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26534363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health