Provider Demographics
NPI:1699982439
Name:COX, ROBERT N (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:COX
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 FALCON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8619
Mailing Address - Country:US
Mailing Address - Phone:540-989-0030
Mailing Address - Fax:
Practice Address - Street 1:75 DOGWOOD ACRE RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-4968
Practice Address - Country:US
Practice Address - Phone:540-353-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024134231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S835890001Medicare UPIN
VA500000490Medicare ID - Type UnspecifiedTRAILBLAZER PROVIDER NUMB