Provider Demographics
NPI:1144300153
Name:ROSCOE, ROBERTA JEAN (CNP, JD)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JEAN
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:CNP, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4230
Mailing Address - Country:US
Mailing Address - Phone:614-457-4709
Mailing Address - Fax:
Practice Address - Street 1:2535 MCCOY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4230
Practice Address - Country:US
Practice Address - Phone:614-457-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03861363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health