Healthcare Provider Details

I. General information

NPI: 1801436910
Provider Name (Legal Business Name): VICTORIA ROQUE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19161 NW 57TH CT
HIALEAH FL
33015-5042
US

IV. Provider business mailing address

19161 NW 57TH CT
HIALEAH FL
33015-5042
US

V. Phone/Fax

Practice location:
  • Phone: 786-488-3304
  • Fax:
Mailing address:
  • Phone: 786-488-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9405352
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number960793
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1176649
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number326247
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355287
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191319
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP002774
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1176649
License Number StateTX
# 9
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: