Provider Demographics
NPI:1619552940
Name:ROA, ANAILY (APRN)
Entity Type:Individual
Prefix:
First Name:ANAILY
Middle Name:
Last Name:ROA
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 1:6213 NW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-1974
Mailing Address - Country:US
Mailing Address - Phone:561-797-4656
Mailing Address - Fax:
Practice Address - Street 1:6213 NW 45TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-1974
Practice Address - Country:US
Practice Address - Phone:561-797-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily