Provider Demographics
NPI:1285349233
Name:ROTH, VERONICA RENEE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:RENEE
Last Name:ROTH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-4813
Mailing Address - Country:US
Mailing Address - Phone:936-776-4517
Mailing Address - Fax:936-253-8910
Practice Address - Street 1:723 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4813
Practice Address - Country:US
Practice Address - Phone:936-776-4517
Practice Address - Fax:936-253-8910
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily