Healthcare Provider Details

I. General information

NPI: 1770194136
Provider Name (Legal Business Name): ROCK J SAINT LOUIS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-6623
  • Fax:
Mailing address:
  • Phone: 786-556-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008327
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPRN11008327
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: