Basic Information
| Provider Information | |||||||||
| NPI: | 1023197613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUM | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1613 N. HARRISON PARKWAY | ||||||||
| Address2: | SUITE 200, MAILSTOP SH-9A | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
| FaxNumber: | 9548511746 | ||||||||
| Practice Location | |||||||||
| Address1: | 7800 SHERIDAN STREET | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549629650 | ||||||||
| FaxNumber: | 9543415165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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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 | 367A00000X | 185229 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | R878113 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | APRN9305336 | FL | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 185229 | 01 | GA | LICENSE | OTHER | 04871800 | 05 | MS | MEDICAID | ARNP9305336 | 01 | FL | FLORIDA LICENSE | OTHER | R878113 | 01 | MS | MS CNM LICENSE | OTHER |