Provider Demographics
NPI:1770936429
Name:ROULHAC, TWILA ALISA
Entity type:Individual
Prefix:MRS
First Name:TWILA
Middle Name:ALISA
Last Name:ROULHAC
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 1:5639 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLTON
Mailing Address - State:FL
Mailing Address - Zip Code:32426-6902
Mailing Address - Country:US
Mailing Address - Phone:850-814-5346
Mailing Address - Fax:
Practice Address - Street 1:5639 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLTON
Practice Address - State:FL
Practice Address - Zip Code:32426-6902
Practice Address - Country:US
Practice Address - Phone:850-814-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor