1669832937 NPI number — ROBYN CARROLL-YENKO M.S., NCSP

Table of content: ROBYN CARROLL-YENKO M.S., NCSP (NPI 1669832937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669832937 NPI number — ROBYN CARROLL-YENKO M.S., NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARROLL-YENKO
Provider First Name:
ROBYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., NCSP
Provider Gender Code:
F

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:
1669832937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/08/2017
NPI Reactivation Date:
01/13/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 561348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-412-4105
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 OAKLEDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-5612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-412-4105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2016

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: 103TS0200X , with the licence number:  SS1222 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com