Basic Information
| Provider Information | |||||||||
| NPI: | 1235186578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS-SMITH | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | SUE-MARIE | ||||||||
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| Credential: | MPAS,PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 W PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | DELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327203260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867380322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 W PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | DELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327203260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867380322 | ||||||||
| FaxNumber: | 3867380628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA3744 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.