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General NPI Number Information
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NPI Number | 1164524039
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Entity Type | Organization
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Legal Business Name | PATIENTS FIRST LAKE ELLA MEDICAL CENTER P A
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 1690 N MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-5533
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Country | US
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Telephone | 850-385-2222
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Fax | 850-385-1844
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Provider Business Mailing Address
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Address Line | 1690 N MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-5533
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Country | US
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Telephone | 850-385-2222
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Fax | 770-626-3791
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA MALIK ROE
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Credential |
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Telephone | 678-504-6392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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