Provider Demographics
NPI:1467802892
Name:ROQUE, MARK CHRISTOPHER (APRN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:ROQUE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13933 17TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4604
Mailing Address - Country:US
Mailing Address - Phone:352-567-6763
Mailing Address - Fax:352-567-2146
Practice Address - Street 1:13933 17TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4604
Practice Address - Country:US
Practice Address - Phone:352-567-6763
Practice Address - Fax:352-567-2146
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN3091802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily