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General NPI Number Information
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NPI Number | 1003604752
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Entity Type | Individual
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Provider Name | DEVIN MARY ROACH PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 112 N OAK ST
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City | LANTANA
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State | FL
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Zip | 33462-3260
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Country | US
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Telephone | 888-482-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 723 NE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2623
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Country | US
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Telephone | 954-309-8314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11039150
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License Number State | FL
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