Provider Demographics
NPI:1114468261
Name:ROLAND, TEAERA L (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:TEAERA
Middle Name:L
Last Name:ROLAND
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7170 ASHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8721
Mailing Address - Country:US
Mailing Address - Phone:513-444-7212
Mailing Address - Fax:
Practice Address - Street 1:7170 ASHVIEW LN
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-8721
Practice Address - Country:US
Practice Address - Phone:513-444-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267951Medicaid