Basic Information
| Provider Information | |||||||||
| NPI: | 1932685856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARDIS | ||||||||
| FirstName: | ROCHELLE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WHETSTONE PL | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320865774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043428300 | ||||||||
| FaxNumber: | 9043428301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 MEDICAL PKWY STE 407B | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786135015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122497190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN11018952 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AP138246 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 825385 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.