Provider Demographics
NPI:1629012885
Name:ROLDAN, IGDALIS (APRN)
Entity Type:Individual
Prefix:MS
First Name:IGDALIS
Middle Name:
Last Name:ROLDAN
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 1:1460 SW 67TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5144
Mailing Address - Country:US
Mailing Address - Phone:954-861-7522
Mailing Address - Fax:954-916-9436
Practice Address - Street 1:1460 SW 67TH TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5144
Practice Address - Country:US
Practice Address - Phone:954-861-7522
Practice Address - Fax:954-916-9436
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1737192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302121100Medicaid
FLY7130OtherBS/BC
FLAPRN1737192OtherSTATE LICENSE
FLY7130OtherBS/BC
FL302121100Medicaid