MEDICARE: ANGIE ROJAS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1104279	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UNSURE	OTHER		UNSURE

General Provider Information

NPI Number	:	1124645742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE ROJAS NP

Provider Business Mailing Address
First Line	:	440 N SCENIC HWY
Second Line	:
City	:	BABSON PARK
State	:	FL
Zip	:	33827-8709
Country	:	US
Telephone Number	:	863-978-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1400
Country	:	US
Telephone Number	:	407-818-1664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2020
Last Update Date	:	06/30/2020

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