Healthcare Provider Details

I. General information

NPI: 1063077469
Provider Name (Legal Business Name): CECILIA RUZENA ROLDAN PERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E RIO SALADO PKWY STE 300
TEMPE AZ
85281-9130
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 400
BRENTWOOD TN
37027-8087
US

V. Phone/Fax

Practice location:
  • Phone: 615-465-8684
  • Fax: 629-240-6003
Mailing address:
  • Phone: 615-465-8684
  • Fax: 629-240-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number89339
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: