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Individual

GAVIN ROACHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 782-3131
Mailing address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(863) 370-9555

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP021669
PA
363LF0000X
Family Nurse Practitioner
APRN11004127
FL
363LF0000X
Family Nurse Practitioner
SP021669
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016388100
FL
Enumeration date
07/16/2014
Last updated
04/16/2021
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