Provider Demographics
NPI:1215640156
Name:IMAM OBIKWU, ROXANNE PATRICIA (MSN, APRN, FNP - BC)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:PATRICIA
Last Name:IMAM OBIKWU
Suffix:
Gender:F
Credentials:MSN, APRN, FNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SAINT EMMA DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4515
Mailing Address - Country:US
Mailing Address - Phone:305-450-4480
Mailing Address - Fax:
Practice Address - Street 1:425 SAINT EMMA DR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4515
Practice Address - Country:US
Practice Address - Phone:305-450-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily