Provider Demographics
NPI:1376626564
Name:ROQUE, FLORENCE C (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:C
Last Name:ROQUE
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S 8TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4007
Mailing Address - Country:US
Mailing Address - Phone:575-936-4350
Mailing Address - Fax:575-936-4351
Practice Address - Street 1:1020 S 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4007
Practice Address - Country:US
Practice Address - Phone:575-936-4350
Practice Address - Fax:575-936-4351
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01614363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5558582Medicaid
AZ965048Medicaid
NM5558582Medicaid
AZ965048Medicaid