Provider Demographics
NPI:1215088232
Name:ROQUES, TETLA M (RN)
Entity type:Individual
Prefix:MRS
First Name:TETLA
Middle Name:M
Last Name:ROQUES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 HONE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3709
Mailing Address - Country:US
Mailing Address - Phone:718-515-5560
Mailing Address - Fax:
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296438-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY296438-1OtherREGISTERED NURSE