Provider Demographics
NPI:1740870054
Name:MCCOY, ROSHAWNDA LESETTE (APRN)
Entity type:Individual
Prefix:
First Name:ROSHAWNDA
Middle Name:LESETTE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9591 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-1934
Mailing Address - Country:US
Mailing Address - Phone:334-221-6193
Mailing Address - Fax:
Practice Address - Street 1:9591 GARDEN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-1934
Practice Address - Country:US
Practice Address - Phone:334-221-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily