Healthcare Provider Details

I. General information

NPI: 1679553648
Provider Name (Legal Business Name): NANETTE ROLLENE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD
CELEBRATION FL
34747-5164
US

IV. Provider business mailing address

333 S DESPLAINES ST STE 201
CHICAGO IL
60661-5514
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-1669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME145761
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberDR.0067673
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD90859
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number313647
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number50123
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: