Provider Demographics
NPI:1962971028
Name:ROBERSON, DAKEISHA
Entity type:Individual
Prefix:
First Name:DAKEISHA
Middle Name:
Last Name:ROBERSON
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 1:422 N 18TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-7982
Mailing Address - Country:US
Mailing Address - Phone:561-574-7652
Mailing Address - Fax:
Practice Address - Street 1:422 N 18TH ST APT B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-7982
Practice Address - Country:US
Practice Address - Phone:561-574-7652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide