1033400122 NPI number — ROBERT ANTHONY OTERO MSN, FNP-BC

Table of content: ROBERT ANTHONY OTERO MSN, FNP-BC (NPI 1033400122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033400122 NPI number — ROBERT ANTHONY OTERO MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTERO
Provider First Name:
ROBERT
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033400122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
931 W. OAK STREET STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-4973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-931-0444
Provider Business Mailing Address Fax Number:
407-962-4446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6735 CONROY RD STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32835-3568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-313-0044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP3317762 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: CNP-03319 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CNP03319 . This is a "NEW MEXICO BOARD OF NURSING" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: ARNP3317762 . This is a "ARNP LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".