Provider Demographics
NPI:1235837030
Name:ROCHA, RUSSELL JOSHUA (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JOSHUA
Last Name:ROCHA
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 ANGLER DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2383
Mailing Address - Country:US
Mailing Address - Phone:561-703-0311
Mailing Address - Fax:
Practice Address - Street 1:4600 MILITARY TRL STE 115
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4811
Practice Address - Country:US
Practice Address - Phone:561-776-5252
Practice Address - Fax:561-776-5255
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily