Provider Demographics
NPI:1992140990
Name:PATRICK, ROBIN B
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:B
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 WOODLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8926
Mailing Address - Country:US
Mailing Address - Phone:407-851-7160
Mailing Address - Fax:407-479-3567
Practice Address - Street 1:2303 WOODLEAF CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8926
Practice Address - Country:US
Practice Address - Phone:407-851-7160
Practice Address - Fax:407-479-3567
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJF5740171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL671714401OtherMEDICAID WAIVER