Provider Demographics
NPI:1053180042
Name:ROBE, JENNICA K
Entity type:Individual
Prefix:
First Name:JENNICA
Middle Name:K
Last Name:ROBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4120
Mailing Address - Country:US
Mailing Address - Phone:813-598-2578
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2244
Practice Address - Country:US
Practice Address - Phone:813-598-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health