MEDICARE: ROXANNA MICHELLE NEGRON

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	156FX1800X	Optician	8321	FL

General Provider Information

NPI Number	:	1417808577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNA MICHELLE NEGRON

Provider Business Mailing Address
First Line	:	2755 RIDGE HAVEN ST
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-5281
Country	:	US
Telephone Number	:	904-934-6920
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 OMNI DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-4171
Country	:	US
Telephone Number	:	904-934-6920
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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