Provider Demographics
NPI:1730518655
Name:ROUGHT, ARIELLE B (PA)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:B
Last Name:ROUGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ARIELLE
Other - Middle Name:A
Other - Last Name:BALDASSARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:151 SOUTHHALL LANE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:2893 ENTERPRISE RD STE 100
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2784
Practice Address - Country:US
Practice Address - Phone:386-789-8600
Practice Address - Fax:386-789-0219
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant