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1386928380

NPI Code Detail

MEDICARE: ANA MARIA PENA ROLDAN

MEDICARE: ANA MARIA PENA ROLDAN

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	235Z00000X	Speech-Language Pathologist	01-0001221	DE
2	235Z00000X	Speech-Language Pathologist	121643	TX
3	235Z00000X	Speech-Language Pathologist	12669	NC

General Provider Information

NPI Number	:	1386928380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MARIA PENA ROLDAN

Provider Business Mailing Address
First Line	:	404 MAPLE ST
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-4917
Country	:	US
Telephone Number	:	910-455-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BROADHURST RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-3551
Country	:	US
Telephone Number	:	910-455-2211
Fax Number	:

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	06/08/2026

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Directions to “ ANA MARIA PENA ROLDAN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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