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NPI Code Detail

MEDICARE: ANDREW JACOB ROUSH

MEDICARE: ANDREW JACOB ROUSH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2000038169UT
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1780210062
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JACOB ROUSH
Provider Business Mailing Address
First Line : 7138 SW 80TH TER
Second Line :
City : GAINESVILLE
State : FL
Zip : 32608-8412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-265-9593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2020
Last Update Date : 02/17/2026

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