MEDICARE: ELIZABETH ROCHE PA

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	363A00000X	Physician Assistant	C01449	MD
2	363A00000X	Physician Assistant	PA9106092	FL

General Provider Information

NPI Number	:	1790724144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROCHE PA

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13685 DOCTORS WAY
Second Line	:	SUITE 310
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4336
Country	:	US
Telephone Number	:	239-343-1400
Fax Number	:	239-343-1430

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	10/21/2020

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Directions to “ ELIZABETH ROCHE PA” Practice Location

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