Provider Demographics
NPI:1588909600
Name:REED, ROBINETTE CAMILLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ROBINETTE
Middle Name:CAMILLE
Last Name:REED
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ROBINETTE
Other - Middle Name:CAMILLE
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:1500 S WATSON RD STE C104
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8689
Practice Address - Country:US
Practice Address - Phone:623-251-7559
Practice Address - Fax:623-266-4012
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ881842Medicaid
AZZ163552OtherMEDICARE