Healthcare Provider Details

I. General information

NPI: 1124645742
Provider Name (Legal Business Name): ANGIE ROJAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1400
US

IV. Provider business mailing address

440 N SCENIC HWY
BABSON PARK FL
33827-8709
US

V. Phone/Fax

Practice location:
  • Phone: 407-818-1664
  • Fax:
Mailing address:
  • Phone: 863-978-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1104279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: