Healthcare Provider Details

I. General information

NPI: 1154046456
Provider Name (Legal Business Name): THEODORA ROILAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 11/23/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8332 W THUNDERBIRD RD
PEORIA AZ
85381-4822
US

IV. Provider business mailing address

8332 W THUNDERBIRD RD
PEORIA AZ
85381-4822
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number275984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: