Healthcare Provider Details

I. General information

NPI: 1346124062
Provider Name (Legal Business Name): PAIGE ALLISON ROSCOE DNP, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 SANDLAKE COMMONS BLVD STE 127
ORLANDO FL
32819-8011
US

IV. Provider business mailing address

7300 SANDLAKE COMMONS BLVD STE 127
ORLANDO FL
32819-8011
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-843-6947
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-843-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11019554
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9525261
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2328123
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11019554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: