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General NPI Number Information
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NPI Number | 1205288412
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Entity Type | Organization
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Legal Business Name | ROLLER GYNECOLOGY LLC
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 36739 STATE ROAD 52 SUITE 101
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City | DADE CITY
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State | FL
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Zip | 33525-5101
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Country | US
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Telephone | 813-333-5233
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Fax | 813-940-3234
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Provider Business Mailing Address
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Address Line | 36739 STATE ROAD 52 SUITE 101
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City | DADE CITY
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State | FL
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Zip | 33525-5101
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Country | US
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Telephone | 813-333-5233
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Fax | 813-940-3234
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. JENNIFER R ROLLER
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Credential | MD
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Telephone | 18133335233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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