Provider Demographics
NPI:1053384537
Name:STARR, ROBIN H (NP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:H
Last Name:STARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5503
Mailing Address - Country:US
Mailing Address - Phone:843-945-1452
Mailing Address - Fax:843-945-1489
Practice Address - Street 1:603 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5503
Practice Address - Country:US
Practice Address - Phone:843-945-1452
Practice Address - Fax:843-945-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-01561363LG0600X
SC19708363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19708OtherSTATE LICENSE
NV100504506Medicaid
SC19708OtherSTATE LICENSE