Provider Demographics
NPI:1871018762
Name:EGGERT, ROANNA MICHELLE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ROANNA
Middle Name:MICHELLE
Last Name:EGGERT
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:ROANNA
Other - Middle Name:MICHELLE
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14100 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-9900
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:727-824-8134
Practice Address - Street 1:7550 43RD ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3601
Practice Address - Country:US
Practice Address - Phone:727-824-8181
Practice Address - Fax:727-541-7984
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9254321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6054648OtherAETNA HEALTHCARE
FL3214323OtherCOVENTRY HEALTHCARE
FLHE470OtherFLORIDA BLUE
FL023459500Medicaid