Organization · Type 2 NPI

Rodaphne Advanced Healthcare Provider, LLC

Nurse Practitioner · Port St. Lucie, FL

NPI number 1417870783 Active

Practice location

1860 SW Fountainview Blvd Ste 100
Port St. Lucie, FL 34986-4528

Fax (772) 404-7936

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000XNone listed
Family Nurse Practitioner 363LF0000XNone listed
Psychiatric/Mental Health Nurse Practitioner 363LP0808XNone listed

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1417870783

Rodaphne Advanced Healthcare Provider, LLC's National Provider Identifier is 1417870783, issued on Aug 3, 2026. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Port St. Lucie, FL. The record was last updated on Aug 3, 2026.