Mandy Jo Roth, DNP, APRN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11025764 Issued in FL

Practice address

725 N 12TH Ave BLDG B
Arcadia, FL 34266-8752

Phone

(863) 494-1242

Fax

(863) 491-0466

NPI assigned

Apr 5, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coastal Community Health Services IncGroup PAC ID 0345463683, 54 clinicians

Balanced Wellbeing LLCGroup PAC ID 5193021848, 228 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Balanced Wellbeing LLC

  • Psychiatry Physician
  • Ocala, FL
  • NPI 1336513639
  Medicare reassignment Care Compare group NPD
• Coastal Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fernandina Beach, FL
  • NPI 1851131874
  Medicare reassignment Care Compare group NPD
• MCR Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Parrish, FL
  • NPI 1255376000
  Medicare reassignment NPD
• MCR Health, Inc.

  • Non-Pharmacy Dispensing Site
  • Bradenton, FL
  • NPI 1821878745
  NPD
• Coastal Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brunswick, GA
  • NPI 1063282937
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1558056671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 GRANT PL",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015600",
            "telephone_number": "314-856-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 N 12TH AVE BLDG B",
            "city": "ARCADIA",
            "state": "FL",
            "postal_code": "342668752",
            "telephone_number": "863-494-1242",
            "fax_number": "863-491-0466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2015 Grant Pl",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329015600",
            "country_code": "US",
            "telephone_number": "314-856-2275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROTH",
        "first_name": "MANDY",
        "middle_name": "JO",
        "credential": "DNP, APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-05",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2023006955",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11025764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard J Rompre, FNP
• Dora A Rosales, LPN
• Katyna Rosario, MD
• Carey Rose, P.A.
• Jeanne Rosenberg, OTR
• Shayla Michelle Routh, PTA
• S Antoine Enterprises
• Marilyn Oropesa Sabado, PHARMACIST
• Sacred Sunflower Wellness Solutions, Inc.
• Tityana Scarbrough

• Psychiatric/Mental Health Nurse Practitioner in Arcadia, FL
• Providers in Arcadia, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.