Provider Demographics
NPI:1528206968
Name:ROGERO, MICHELE GRIFFIN (CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:GRIFFIN
Last Name:ROGERO
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:TAMI LEE
Other - Middle Name:MICHELE
Other - Last Name:ROGERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM, ARNP
Mailing Address - Street 1:6600 CHARING STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-674-0022
Mailing Address - Fax:904-425-0192
Practice Address - Street 1:6600 CHARING STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-674-0022
Practice Address - Fax:904-425-0192
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3272082367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000606000Medicaid
FLY139AOtherBCBS
FL1528206968OtherTRICARE