Healthcare Provider Details

I. General information

NPI: 1124680673
Provider Name (Legal Business Name): NANCY CAROLINE ROE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 N OAK ST STE C
VALDOSTA GA
31602-1885
US

IV. Provider business mailing address

PO BOX 2650
TIFTON GA
31793-2650
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-1570
  • Fax: 229-299-4291
Mailing address:
  • Phone: 229-402-0425
  • Fax: 229-353-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP235374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: