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General NPI Number Information
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NPI Number | 1912261710
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Entity Type | Individual
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Provider Name | MELISSA JOY ROEBUCK-WATERS APRN
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Gender | Female
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 3449 SW STATE ROAD 26
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City | TRENTON
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State | FL
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Zip | 32693-5641
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Country | US
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Telephone | 352-463-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 3449 SW STATE ROAD 26
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City | TRENTON
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State | FL
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Zip | 32693-5641
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Country | US
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Telephone | 352-463-4895
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9226980
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License Number State | FL
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