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NPI Code Detail

MEDICARE: ELAINE ROUCO PEREZ

MEDICARE: ELAINE ROUCO PEREZ
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
1363A00000XPhysician AssistantPA9109133FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639540453
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELAINE ROUCO PEREZ
Provider Business Mailing Address
First Line : 6822 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-2212
Country : US
Telephone Number : 813-280-4909
Fax Number : 813-302-7143
Provider Business Practice Location Address
First Line : 6822 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-2212
Country : US
Telephone Number : 813-280-4909
Fax Number : 813-302-7143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2015
Last Update Date : 08/29/2024

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Directions to “ ELAINE ROUCO PEREZ ” Practice Location

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