Provider Demographics
NPI:1427055318
Name:COOK, ROXANN CASTELLI (DO)
Entity type:Individual
Prefix:DR
First Name:ROXANN
Middle Name:CASTELLI
Last Name:COOK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MERIDIAN POINT LANE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812
Mailing Address - Country:US
Mailing Address - Phone:863-272-8614
Mailing Address - Fax:
Practice Address - Street 1:2803 MERIDIAN POINT LANE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812
Practice Address - Country:US
Practice Address - Phone:863-272-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 7901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263133400Medicaid
FL593725316OtherCIGNA ID NUMBER
FL48382OtherBCBS ID NUMBER
FL593725316OtherUHC ID NUMBER
FL3689707OtherAETNA ID NUMBER
H69837Medicare UPIN
FL263133400Medicaid