Provider Demographics
NPI:1689653776
Name:ROELKER, EVA (NP)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:ROELKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S TAMIAMI TRL
Mailing Address - Street 2:HEART FAILURE CLINIC
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3509
Mailing Address - Country:US
Mailing Address - Phone:941-917-7867
Mailing Address - Fax:941-917-7193
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:HEART FAILURE CLINIC
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-7867
Practice Address - Fax:941-917-7193
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN063010363LA2100X
FLARNP9363736363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019221700Medicaid
AZ440024Medicaid
S95169Medicare UPIN
AZZ111609Medicare PIN
AZZ145612Medicare PIN
AZ440024Medicaid
FL019221700Medicaid