Provider Demographics
NPI:1306899711
Name:ROLLE, PAULINE J (MD)
Entity type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:J
Last Name:ROLLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 SHIRCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4748
Mailing Address - Country:US
Mailing Address - Phone:904-308-7309
Mailing Address - Fax:904-308-7326
Practice Address - Street 1:3200 3RD ST S STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6097
Practice Address - Country:US
Practice Address - Phone:904-450-7050
Practice Address - Fax:904-450-7059
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2660288-00Medicaid
FL266028800Medicaid
FLH76867Medicare UPIN