MEDICARE: MRS. GINA MARIE ROGEAN APRN

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
1	363L00000X	Nurse Practitioner	11022036	FL

General Provider Information

NPI Number	:	1891419164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA MARIE ROGEAN APRN

Provider Business Mailing Address
First Line	:	5284 EAGLE LAKE DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1537
Country	:	US
Telephone Number	:	954-892-7984
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 MAPLEWOOD DR STE 6
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-5848
Country	:	US
Telephone Number	:	561-744-2724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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