Healthcare Provider Details

I. General information

NPI: 1124600788
Provider Name (Legal Business Name): JOEL NICOLAS ROCHA BSN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

1012 LAKE HEATHER RESERVE # 1012
HOOVER AL
35242-7618
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 334-447-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN10033598
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: