Provider Demographics
NPI:1316634611
Name:ROBINSON, ANGELA DENISE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DENISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 THELMA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-8617
Mailing Address - Country:US
Mailing Address - Phone:501-366-9338
Mailing Address - Fax:
Practice Address - Street 1:7200 THELMA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-8617
Practice Address - Country:US
Practice Address - Phone:501-366-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR05699341001E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health