Provider Demographics
NPI:1770043382
Name:PARKER, ROSLYN DENISE
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:DENISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17356 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-1619
Mailing Address - Country:US
Mailing Address - Phone:904-827-7150
Mailing Address - Fax:904-368-9791
Practice Address - Street 1:17356 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1619
Practice Address - Country:US
Practice Address - Phone:904-827-7150
Practice Address - Fax:904-368-9791
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor