Provider Demographics
NPI:1174927107
Name:STANLEY, ROBIN CHAVON (NP-C)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:CHAVON
Last Name:STANLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SKYLARK WAY
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8373
Mailing Address - Country:US
Mailing Address - Phone:229-322-6295
Mailing Address - Fax:
Practice Address - Street 1:104 8TH ST W STE 3A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3987
Practice Address - Country:US
Practice Address - Phone:229-402-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily