Provider Demographics
NPI:1417472242
Name:IVEY, ROSHANDA K (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ROSHANDA
Middle Name:K
Last Name:IVEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GREAT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3124
Mailing Address - Country:US
Mailing Address - Phone:386-334-0095
Mailing Address - Fax:386-246-7418
Practice Address - Street 1:1001 GREAT OAKS DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3124
Practice Address - Country:US
Practice Address - Phone:386-334-0095
Practice Address - Fax:386-246-7418
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
FLAPRN11009805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator