Basic Information
| Provider Information | |||||||||
| NPI: | 1992858898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | HOUSE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7819 COUNTRY CLUB RD N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337103750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277094014 | ||||||||
| FaxNumber: | 7273434402 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 7TH AVE S | ||||||||
| Address2: | DEPT 7470 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277674403 | ||||||||
| FaxNumber: | 7277674715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | X | Behavioral Health & Social Service Providers | Social Worker | 163WP0200X | RN2943592 | FL | X | Nursing Service Providers | Registered Nurse | Pediatrics |
No ID Information.