Healthcare Provider Details

I. General information

NPI: 1043562663
Provider Name (Legal Business Name): ELIZABETH L ROSZEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STATE ROAD 674
WIMAUMA FL
33598-3515
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-8555
  • Fax: 813-349-7861
Mailing address:
  • Phone: 813-349-7568
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382342-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number648284-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9359224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: