Healthcare Provider Details

I. General information

NPI: 1720844897
Provider Name (Legal Business Name): ROCKER HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10681 LAGO WELLEBY DR
SUNRISE FL
33351-8287
US

IV. Provider business mailing address

10681 LAGO WELLEBY DR
SUNRISE FL
33351-8287
US

V. Phone/Fax

Practice location:
  • Phone: 786-355-8680
  • Fax:
Mailing address:
  • Phone: 786-355-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFF ROCKER
Title or Position: CEO
Credential: LMHC
Phone: 786-355-8680