Healthcare Provider Details

I. General information

NPI: 1528520756
Provider Name (Legal Business Name): MICHAEL J ROGGELIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 N TUTTLE AVE
SARASOTA FL
34237-3116
US

IV. Provider business mailing address

PO BOX 1000 DEPT 394
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-0134
  • Fax: 866-622-3009
Mailing address:
  • Phone: 941-300-4440
  • Fax: 941-404-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11012597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: