Healthcare Provider Details

I. General information

NPI: 1205532025
Provider Name (Legal Business Name): MRS. JANE NICOLE ROLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JANE NICOLE SOLLA

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY APT 904
POMPANO BEACH FL
33069-5387
US

IV. Provider business mailing address

3575 COELEBS AVE
BOYNTON BEACH FL
33436-2704
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 786-479-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: