Individual provider Active NPI

Tarah Roch

  • Family Nurse Practitioner
  • Sunrise, FL
National Provider Identifier
1760012884
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11005071 Issued in FL
Practice address
1000 Sawgrass Corporate Pkwy
Sunrise, FL 33323-2872
Phone
(954) 858-1833
NPI assigned
Jan 16, 2020
Last updated
Oct 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 9280133 FL
Family Nurse Practitioner 363LF0000X 11005071 FL Primary

Addresses

Primary practice location

1000 Sawgrass Corporate Pkwy
Sunrise, FL 33323-2872

Mailing address

PO Box 970254
Coconut Creek, FL 33097-0254
Phone (954) 854-2895

Other practice location 1

401 NW 42nd Ave
Plantation, FL 33317-2835
Phone (954) 587-5010

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9280133FLMDGeneral Practice Registered Nurse
11005071FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maclinik LLC Family CurrentSince Jul 17, 2022 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1760012884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970254",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330970254",
            "telephone_number": "954-854-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 SAWGRASS CORPORATE PKWY",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232872",
            "telephone_number": "954-858-1833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 NW 42nd Ave",
            "address_purpose": "LOCATION",
            "city": "Plantation",
            "state": "FL",
            "postal_code": "333172835",
            "country_code": "US",
            "telephone_number": "954-587-5010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROCH",
        "first_name": "TARAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-16",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "9280133",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11005071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.