Provider Demographics
NPI:1821487836
Name:ROE, THOMASINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:THOMASINA
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W AYLESBURY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4168
Mailing Address - Country:US
Mailing Address - Phone:410-575-1200
Mailing Address - Fax:
Practice Address - Street 1:15 W AYLESBURY RD STE 600
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4168
Practice Address - Country:US
Practice Address - Phone:410-575-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011677363LF0000X
DEL1-0045239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse