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General NPI Number Information
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NPI Number | 1710111679
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Entity Type | Individual
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Provider Name | PATRICIA L. ROCHE MS, RD, CD
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Gender | Female
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 1598 TALLULAH TER
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-7218
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Country | US
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Telephone | 317-850-8497
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 GORHAM CT
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City | CARMEL
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State | IN
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Zip | 46033-3280
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Country | US
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Telephone | 317-850-8497
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 564375
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 564375
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 564375
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 564375
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License Number State |
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