Healthcare Provider Details

I. General information

NPI: 1891300331
Provider Name (Legal Business Name): ROXAND VILLOCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 LAKEVIEW DR UNIT 1001
FERN PARK FL
32730-2050
US

IV. Provider business mailing address

1886 SPRING POND PT APT 400
WINTER SPRINGS FL
32708-2887
US

V. Phone/Fax

Practice location:
  • Phone: 407-900-0613
  • Fax:
Mailing address:
  • Phone: 210-385-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11009110
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: