Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 125.075065 | IL |
NPI | 1003376203 |
---|---|
Provider Name | Dr. Tiffany A Robak |
First Address | Orlando, FL 32822-8204 |
Second Address | Orlando, FL 32822-8204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2019 |
Last Update Date | 19/06/2020 |