Basic Information
| Provider Information | |||||||||
| NPI: | 1235483637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBESON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | OPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
| FaxNumber: | 3523320799 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 W NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
| FaxNumber: | 3523320799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2012 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | Y |
ID Information
| ID | Type | State | Issuer | Description | 930 | 01 | OPA-C - NATIONAL BOARD FOR CERTIFICATION OF ORTHOPAEDIC PHYSICIAN ASSISTANTS | OTHER |