MEDICARE: MRS. HILDA ROCHE APRN

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	207QA0505X	Adult Medicine Physician	11030082	FL
2	363LF0000X	Family Nurse Practitioner	11030082	FL

General Provider Information

NPI Number	:	1396125241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HILDA ROCHE APRN

Provider Business Mailing Address
First Line	:	11201 NW 89TH ST APT 210
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2375
Country	:	US
Telephone Number	:	305-803-8904
Fax Number	:

Provider Business Practice Location Address
First Line	:	4526 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4034
Country	:	US
Telephone Number	:	786-600-7560
Fax Number	:

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	09/22/2025

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