Provider Demographics
NPI:1891204608
Name:FORD, ROXANNA (NP)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3706 N ROOSEVELT BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4566
Mailing Address - Country:US
Mailing Address - Phone:305-517-6613
Mailing Address - Fax:305-292-6477
Practice Address - Street 1:635 1ST ST N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4191
Practice Address - Country:US
Practice Address - Phone:863-294-0670
Practice Address - Fax:863-298-3200
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9266498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily