Healthcare Provider Details

I. General information

NPI: 1295182038
Provider Name (Legal Business Name): LENZETTA ROLLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

IV. Provider business mailing address

7201 N UNIVERSITY DR
TAMARAC FL
33321-2913
US

V. Phone/Fax

Practice location:
  • Phone: 954-724-6540
  • Fax:
Mailing address:
  • Phone: 954-724-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number314465
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number202000603
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS16598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: