Provider Demographics
NPI:1306368394
Name:ROQUE, MIRIANELLYS (CNM)
Entity Type:Individual
Prefix:
First Name:MIRIANELLYS
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N HIATUS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3096
Mailing Address - Country:US
Mailing Address - Phone:954-900-6207
Mailing Address - Fax:954-807-3509
Practice Address - Street 1:1000 N HIATUS RD STE 160
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3096
Practice Address - Country:US
Practice Address - Phone:954-900-6207
Practice Address - Fax:954-807-3509
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9346741176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife