Basic Information
| Provider Information | |||||||||
| NPI: | 1528206968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERO | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | GRIFFIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM, ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROGERO | ||||||||
| OtherFirstName: | TAMI LEE | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CNM, ARNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048191500 | ||||||||
| FaxNumber: | 9048101023 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HEALTH PARK BLVD | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048191500 | ||||||||
| FaxNumber: | 9048101023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP3272082 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 1528206968 | 01 | FL | TRICARE | OTHER | Y139A | 01 | FL | BCBS | OTHER | 000606000 | 05 | FL | MEDICAID |