| NPI | 1740825025 |
|---|---|
| Former Name | TISDREY ROQUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004359) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11004359) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2019-12-19 |