Healthcare Provider Details

I. General information

NPI: 1144898685
Provider Name (Legal Business Name): HADASSAH ROONEY PMHNP. BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 INDIAN COVE LANE
PONTE VEDRA BEACH FL
32082
US

IV. Provider business mailing address

130 INDIAN COVE LANE
PONTE VEDRA BEACH FL
32082
US

V. Phone/Fax

Practice location:
  • Phone: 904-864-3272
  • Fax:
Mailing address:
  • Phone: 904-864-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11012810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: