Provider Demographics
NPI:1194759415
Name:BOBILIN, ROBERT KINGSLEY (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KINGSLEY
Last Name:BOBILIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-7955
Mailing Address - Fax:352-265-7996
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-7955
Practice Address - Fax:253-265-7996
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292661000Medicaid
U3191YMedicare PIN
Q24535Medicare UPIN
FLU3191VMedicare PIN
FLU3191XMedicare PIN
FL292661000Medicaid
FLU3191WMedicare PIN