MEDICARE: AMY ROCCO PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0026887	OH

General Provider Information

NPI Number	:	1316563463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ROCCO PMHNP

Provider Business Mailing Address
First Line	:	2948 MEADOW LN
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-4940
Country	:	US
Telephone Number	:	216-375-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 E WASHINGTON ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3338
Country	:	US
Telephone Number	:	330-935-7443
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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