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Individual

MANDY JO ROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP, APRN, PMHNP-BC

Contact information

Practice address
725 N 12TH AVE BLDG B, ARCADIA, FL 34266-8752
(863) 494-1242
(863) 491-0466
Mailing address
2015 GRANT PL, MELBOURNE, FL 32901-5600
(314) 856-2275

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2023006955
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11025764
FL

Other

Enumeration date
04/05/2023
Last updated
05/08/2024
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