Healthcare Provider Details

I. General information

NPI: 1295572337
Provider Name (Legal Business Name): ADRIANA ROQUE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9279 W 33RD LN
HIALEAH FL
33018-2067
US

IV. Provider business mailing address

9279 W 33RD LN
HIALEAH FL
33018-2067
US

V. Phone/Fax

Practice location:
  • Phone: 786-374-6396
  • Fax:
Mailing address:
  • Phone: 786-374-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11029357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: