Provider Demographics
NPI:1407279227
Name:ROACHE, RENALDO OMALEE (CRNA)
Entity Type:Individual
Prefix:
First Name:RENALDO
Middle Name:OMALEE
Last Name:ROACHE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15422 SW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6749
Mailing Address - Country:US
Mailing Address - Phone:305-926-1431
Mailing Address - Fax:
Practice Address - Street 1:15422 SW 176TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6749
Practice Address - Country:US
Practice Address - Phone:305-926-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771242163W00000X, 367500000X
FLRN9273737367500000X
FLARNP9273737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse