Healthcare Provider Details

I. General information

NPI: 1336863422
Provider Name (Legal Business Name): ROXANNE SPENCER HOBBS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/15/2024
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39208 COPRICE ST
PALMDALE CA
93551-4479
US

IV. Provider business mailing address

39208 COPRICE ST
PALMDALE CA
93551-4479
US

V. Phone/Fax

Practice location:
  • Phone: 661-236-8917
  • Fax:
Mailing address:
  • Phone: 661-236-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: