Provider Demographics
NPI:1407227283
Name:LUNA, ROCHELLE (PA)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 CONWAY RD
Mailing Address - Street 2:# 280
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5991
Mailing Address - Country:US
Mailing Address - Phone:941-228-2303
Mailing Address - Fax:
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:SUITE 203
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-430-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant