Provider Demographics
NPI:1508633157
Name:PHILLIP, ROXANNE A
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:A
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HUNTING LODGE DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-7007
Mailing Address - Country:US
Mailing Address - Phone:813-857-7699
Mailing Address - Fax:
Practice Address - Street 1:415 HUNTING LODGE DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-7007
Practice Address - Country:US
Practice Address - Phone:813-857-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9536337163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse