Provider Demographics
NPI:1093006660
Name:ROAN, GLORIA JEAN (RRT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:ROAN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 NW 187TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3256
Mailing Address - Country:US
Mailing Address - Phone:786-303-1980
Mailing Address - Fax:
Practice Address - Street 1:2320 NW 187TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI GARDEN
Practice Address - State:FL
Practice Address - Zip Code:33056
Practice Address - Country:US
Practice Address - Phone:786-303-1980
Practice Address - Fax:305-756-9948
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT1026227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered