Provider Demographics
NPI:1871077487
Name:ROBINSON, KACIE (APRN)
Entity type:Individual
Prefix:MS
First Name:KACIE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 MERRY FAWN CT
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6783
Mailing Address - Country:US
Mailing Address - Phone:727-366-4049
Mailing Address - Fax:
Practice Address - Street 1:5454 CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6129
Practice Address - Country:US
Practice Address - Phone:727-498-8608
Practice Address - Fax:727-498-8608
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9318733363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care