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General NPI Number Information
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NPI Number | 1659363430
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Entity Type | Individual
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Provider Name | NANCY MOULTRIE ROCKSTROH MD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | JAX-NAS NAVAL HOSPITAL 2080 CHILD STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5000
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Country | US
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Telephone | 904-542-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 333 CEDAR RUN DR
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City | ORANGE PARK
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State | FL
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Zip | 32003-8156
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Country | US
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Telephone | 901-215-8485
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 33926
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME99966
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License Number State | FL
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