Provider Demographics
NPI:1144114364
Name:HODGE-ROCOURT, GERARD ROMELO
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:ROMELO
Last Name:HODGE-ROCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 ARIANA ELYSE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1478
Mailing Address - Country:US
Mailing Address - Phone:732-439-9303
Mailing Address - Fax:
Practice Address - Street 1:550 BALMORAL CIR N STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5577
Practice Address - Country:US
Practice Address - Phone:561-951-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist