Organization Name: | BABA HEALTHCARE |
NPI Number: | 1609268614 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE CAROL ROBERSON (INSURANCE CREDENTAILING) |
Mailing Address: | 948 S Wickham Rd Ste W Melbourne |
State: | FL US |
Postal Code: | 329041647 |
Phone Number: | 3219567370 |
Fax Number: | 3219567873 |
NPI Enumeration Date: | 02/27/2015 |
NPI Last Update Date: | 02/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | ARNP 9179052 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |