Healthcare Provider Details

I. General information

NPI: 1780416578
Provider Name (Legal Business Name): ROODELYNE PETIT-HOMME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11190 HEALTH PARK BLVD
NAPLES FL
34110-5729
US

IV. Provider business mailing address

16401 NW 37TH AVE
MIAMI GARDENS FL
33054-6313
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: