Provider Demographics
NPI:1144893959
Name:ENACHE, ROXANA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:
Last Name:ENACHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:501 RANGEWOOD RD
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4537
Practice Address - Country:US
Practice Address - Phone:813-598-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant