Provider Demographics
NPI:1710422399
Name:LE ROUX, VOLA HARIVONY (NP)
Entity Type:Individual
Prefix:MS
First Name:VOLA
Middle Name:HARIVONY
Last Name:LE ROUX
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 1:1213 24TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2595
Mailing Address - Country:US
Mailing Address - Phone:361-694-1498
Mailing Address - Fax:361-694-1499
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 402
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5169
Practice Address - Country:US
Practice Address - Phone:386-231-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60980669163W00000X
WAAP60981182363L00000X
TXAP132489363LF0000X
FLAPRN11003171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX555246YLPSOtherWELLMED PTAN