Healthcare Provider Details

I. General information

NPI: 1184237729
Provider Name (Legal Business Name): JORJA ROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 TOWNE LAKE DR STE 1
FORT MYERS FL
33913-8021
US

IV. Provider business mailing address

12220 TOWNE LAKE DR STE 1
FORT MYERS FL
33913-8021
US

V. Phone/Fax

Practice location:
  • Phone: 239-821-1271
  • Fax:
Mailing address:
  • Phone: 239-821-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: