Provider Demographics
NPI:1225236698
Name:MORGAN, ROXANNE MARKOV (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARKOV
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 TRAFFIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3341
Mailing Address - Country:US
Mailing Address - Phone:805-473-3262
Mailing Address - Fax:805-473-3707
Practice Address - Street 1:154 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3341
Practice Address - Country:US
Practice Address - Phone:805-473-3262
Practice Address - Fax:805-473-3707
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5437363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPNP 5437OtherPED NURSE PRAC LICENCE #
CA348252OtherRN LICENSE