Provider Demographics
NPI:1598514721
Name:WALTERS, ROBERT IV (APRN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WALTERS
Suffix:IV
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3841
Mailing Address - Country:US
Mailing Address - Phone:321-800-2922
Mailing Address - Fax:
Practice Address - Street 1:801 N MAGNOLIA AVE STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3841
Practice Address - Country:US
Practice Address - Phone:321-800-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032879363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health