Healthcare Provider Details

I. General information

NPI: 1902680960
Provider Name (Legal Business Name): ANTHONY ANDREW ROQUE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N HANCOCK RD
MINNEOLA FL
34715-8184
US

IV. Provider business mailing address

1800 N HANCOCK RD
MINNEOLA FL
34715-8184
US

V. Phone/Fax

Practice location:
  • Phone: 689-289-2654
  • Fax: 689-289-2655
Mailing address:
  • Phone: 689-289-2654
  • Fax: 689-289-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11028209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: