Healthcare Provider Details

I. General information

NPI: 1093206104
Provider Name (Legal Business Name): ROAN CADAVONA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 6TH ST SE
WINTER HAVEN FL
33880-4605
US

IV. Provider business mailing address

303 TERRANOVA BLVD
WINTER HAVEN FL
33884-3427
US

V. Phone/Fax

Practice location:
  • Phone: 863-419-9301
  • Fax:
Mailing address:
  • Phone: 863-298-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05180059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: