Healthcare Provider Details

I. General information

NPI: 1730452103
Provider Name (Legal Business Name): MARIA C ROQUE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 CLYDE MORRIS BLVD
PORT ORANGE FL
32129-2317
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-4411
  • Fax: 866-542-5859
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9190540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: