Healthcare Provider Details

I. General information

NPI: 1831453943
Provider Name (Legal Business Name): ERIN ELIZABETH ROCA ATC, LAT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 6TH ST S
ST PETERSBURG FL
33701-4827
US

IV. Provider business mailing address

11400 4TH ST N APT 1306
ST PETERSBURG FL
33716-2920
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4257
  • Fax:
Mailing address:
  • Phone: 813-468-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL2834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: