Healthcare Provider Details

I. General information

NPI: 1255873063
Provider Name (Legal Business Name): HECTOR DEJESUS ROCHA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 LAKESIDE VILLAGE LN
WINDERMERE FL
34786-7024
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-2273
  • Fax: 407-347-4450
Mailing address:
  • Phone: 407-876-2273
  • Fax: 407-347-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9242433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: