Healthcare Provider Details

I. General information

NPI: 1245840461
Provider Name (Legal Business Name): NATASHA MEDEROS ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA MEDEROS ROCHA

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 WEST 8TH ST. TOWER 1, 5TH FLOOR, SUITE 513
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

580 WEST 8TH ST. TOWER 1, 5TH FLOOR, SUITE 513
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1013
  • Fax: 904-244-7893
Mailing address:
  • Phone: 904-383-1013
  • Fax: 904-244-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: