Provider Demographics
NPI:1073989547
Name:ROHAN, MAIDELYS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MAIDELYS
Middle Name:
Last Name:ROHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MAIDELYS
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1600 SW ARCHER RD BOX 117500
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-392-1161
Mailing Address - Fax:352-392-9625
Practice Address - Street 1:280 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2038
Practice Address - Country:US
Practice Address - Phone:352-392-1161
Practice Address - Fax:352-392-9625
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9328815363LA2100X
FLARNP9328815363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104447700Medicaid