Provider Demographics
NPI:1114484623
Name:ROCHA, SABRINA SUSIE (LPN)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:SUSIE
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-3803
Mailing Address - Country:US
Mailing Address - Phone:918-857-8891
Mailing Address - Fax:
Practice Address - Street 1:9811 E 12TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-3803
Practice Address - Country:US
Practice Address - Phone:918-857-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0068013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKL082525187Medicaid