Healthcare Provider Details

I. General information

NPI: 1376730861
Provider Name (Legal Business Name): VALENCIA ANIKA ROGERS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 BEACH BLVD STE 203
JACKSONVILLE FL
32207-5120
US

IV. Provider business mailing address

5800 BEACH BLVD STE 203
JACKSONVILLE FL
32207-5120
US

V. Phone/Fax

Practice location:
  • Phone: 904-655-7523
  • Fax:
Mailing address:
  • Phone: 904-655-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9243646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: