Provider Demographics
NPI:1841643772
Name:ROCK, JOANNA ROSE (DO)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:ROSE
Last Name:ROCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-3660
Mailing Address - Fax:239-343-4133
Practice Address - Street 1:708 DEL PRADO BLVD S STE 7
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2676
Practice Address - Country:US
Practice Address - Phone:239-424-3660
Practice Address - Fax:239-343-4133
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10931500207RC0000X
FLOS21465207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124291200Medicaid