Active NPI
Jovan Andrew Roach
- Behavior Technician
- Maitland, FL
National Provider Identifier
1700424876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2301 Maitland Center Pkwy
Maitland, FL 32751-4128 - Phone
- (407) 574-6588
- NPI assigned
- Dec 19, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
2301 Maitland Center Pkwy
Maitland, FL 32751-4128
Mailing address
1205 Sophie Blvd
Orlando, FL 32828-5948
Phone (407) 417-1869
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R200-421-95-335-1 | Other | FL | DRIVERS LICENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576713600000",
"number": "1700424876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 SOPHIE BLVD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328285948",
"telephone_number": "407-417-1869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 MAITLAND CENTER PKWY",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327514128",
"telephone_number": "407-574-6588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "JOVAN",
"middle_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-19",
"last_updated": "2019-12-19",
"certification_date": "2019-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENCE",
"identifier": "R200-421-95-335-1",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maitland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.