Provider Demographics
NPI:1295139319
Name:ROBISON, AMANDA BETH (APRN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BETH
Last Name:ROBISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8903 GLADES RD
Mailing Address - Street 2:STE A11
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2006
Mailing Address - Country:US
Mailing Address - Phone:561-482-7575
Mailing Address - Fax:
Practice Address - Street 1:8803 S 101ST EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-579-2791
Practice Address - Fax:918-579-2799
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK85899363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200563610AMedicaid