Provider Demographics
NPI:1710738067
Name:DUROSIER, ROOSVELT
Entity Type:Individual
Prefix:
First Name:ROOSVELT
Middle Name:
Last Name:DUROSIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOMER AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33973
Mailing Address - Country:US
Mailing Address - Phone:239-321-0475
Mailing Address - Fax:
Practice Address - Street 1:112 HOMER AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33973
Practice Address - Country:US
Practice Address - Phone:239-321-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion