Provider Demographics
NPI:1285380675
Name:ROBERTSON, RONALD JR (SRNA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ROBERTSON
Suffix:JR
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18858 MALINCHE LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-7865
Mailing Address - Country:US
Mailing Address - Phone:813-600-7345
Mailing Address - Fax:
Practice Address - Street 1:18858 MALINCHE LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-7865
Practice Address - Country:US
Practice Address - Phone:813-600-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9342892367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered