Individual
JACLYN R ROTHBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
13330 LAUREL DRIVE, TAMPA, FL 33612
(813) 821-8038
(813) 974-0483
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-0483
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9251094
FL
363LF0000X
Family Nurse Practitioner
ARNP9251094
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309079500
—
FL
01
—
Y03NA
BCBS
FL
Enumeration date
04/01/2008
Last updated
12/14/2023
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