Basic Information
Provider Information
NPI: 1407026719
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CARLISLE
FirstName: ROBYN
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: ARNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1901 SE 18TH AVE
Address2: BLDG 400
City: OCALA
State: FL
PostalCode: 344718215
CountryCode: US
TelephoneNumber: 3527328905
FaxNumber: 3527322307
Practice Location
Address1: 17345 SE 109TH TERRACE RD
Address2:  
City: SUMMERFIELD
State: FL
PostalCode: 344918930
CountryCode: US
TelephoneNumber: 3527514885
FaxNumber: 3527515371
Other Information
ProviderEnumerationDate: 03/04/2008
LastUpdateDate: 07/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X9247423FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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