Basic Information
Provider Information
NPI: 1548456403
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBBLEE
FirstName: ANN
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2900 CORPORATE WAY
Address2: DOOR D
City: MIRAMAR
State: FL
PostalCode: 330253925
CountryCode: US
TelephoneNumber: 9542765581
FaxNumber: 9549857074
Practice Location
Address1: 1150 N 35TH AVE
Address2: SUITE 605
City: HOLLYWOOD
State: FL
PostalCode: 330215424
CountryCode: US
TelephoneNumber: 9549654900
FaxNumber: 9545151200
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 03/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA9102130FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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