Active NPI
Elizabeth Roche, PA
- Physician Assistant
- Fort Myers, FL
National Provider Identifier
1790724144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9106092
- Practice address
- 13685 Doctors Way
Suite 310
Fort Myers, FL 33912-4336 - Phone
- (239) 343-1400
- Fax
- (239) 343-1430
- NPI assigned
- Jun 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C01449 | MD | |
| Physician Assistant | 363A00000X | PA9106092 | FL | Primary |
Addresses
Primary practice location
13685 Doctors Way
Suite 310
Fort Myers, FL 33912-4336
Mailing address
PO Box 2147
Fort Myers, FL 33902-2147
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9106092 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603238400000",
"number": "1790724144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2147",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339022147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13685 DOCTORS WAY",
"address_2": "SUITE 310",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339124336",
"telephone_number": "239-343-1400",
"fax_number": "239-343-1430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROCHE",
"first_name": "ELIZABETH",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-04",
"last_updated": "2020-10-21",
"certification_date": "2020-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C01449",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9106092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.