Provider Demographics
NPI:1881137420
Name:ROACHE, BEVERLEY (LPN)
Entity type:Individual
Prefix:MISS
First Name:BEVERLEY
Middle Name:
Last Name:ROACHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7903
Mailing Address - Country:US
Mailing Address - Phone:407-879-8245
Mailing Address - Fax:407-868-9537
Practice Address - Street 1:5304 NW 16TH ST
Practice Address - Street 2:APT.#1
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5490
Practice Address - Country:US
Practice Address - Phone:954-243-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5209894164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse