Individual
THOMAS ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
421 S KEECH ST, DAYTONA BEACH, FL 32114-4623
(386) 238-4980
Mailing address
421 S KEECH ST, DAYTONA BEACH, FL 32114-4623
(386) 238-4980
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN9169753
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312001500
—
FL
Enumeration date
03/23/2007
Last updated
05/13/2008
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