Healthcare Provider Details

I. General information

NPI: 1033972625
Provider Name (Legal Business Name): TONI A ROLLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 VICTORIA ST
BRANDON FL
33510-4100
US

IV. Provider business mailing address

701 N FEDERAL HWY STE 601
HALLANDALE BEACH FL
33009-2467
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-4220
  • Fax:
Mailing address:
  • Phone: 954-482-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11030699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: