Provider Demographics
NPI:1174868764
Name:ROBELLI, SALLY JO (ARNP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JO
Last Name:ROBELLI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:SUITE 311 WEST TOWER
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-654-2445
Mailing Address - Fax:813-654-9885
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 311 WEST TOWER
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-654-2445
Practice Address - Fax:813-654-9885
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2732342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01135660OtherR&R MEDICARE
FLGW791ZMedicare PIN