Provider Demographics
NPI:1780128645
Name:ROLDAN, JESSICA LYNNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNNE
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23711 SW 212TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-1072
Mailing Address - Country:US
Mailing Address - Phone:786-663-4859
Mailing Address - Fax:
Practice Address - Street 1:975 BAPTIST WAY STE 203
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033
Practice Address - Country:US
Practice Address - Phone:305-274-7800
Practice Address - Fax:305-270-1246
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9169174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily