Provider Demographics
NPI:1194975466
Name:ROTH, JOANNA BELLE (MS, ACNP-BC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:BELLE
Last Name:ROTH
Suffix:
Gender:F
Credentials:MS, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21764 OMEGA CT
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7809
Mailing Address - Country:US
Mailing Address - Phone:574-891-4920
Mailing Address - Fax:574-891-4902
Practice Address - Street 1:21764 OMEGA CT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-7809
Practice Address - Country:US
Practice Address - Phone:574-891-4920
Practice Address - Fax:574-891-4902
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002933A2083B0002X, 363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care