Provider Demographics
NPI:1720645344
Name:SPENCER, ROBBIN M (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 WESTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5028
Mailing Address - Country:US
Mailing Address - Phone:185-690-4420
Mailing Address - Fax:518-690-4427
Practice Address - Street 1:1873 WESTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5028
Practice Address - Country:US
Practice Address - Phone:518-690-4420
Practice Address - Fax:518-690-4427
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011319207R00000X
NYF308619-1363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty