Provider Demographics
NPI:1588702732
Name:POETA, ROCKEY IV (DC, FNP-C)
Entity type:Individual
Prefix:DR
First Name:ROCKEY
Middle Name:
Last Name:POETA
Suffix:IV
Gender:M
Credentials:DC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3051
Mailing Address - Country:US
Mailing Address - Phone:302-354-0980
Mailing Address - Fax:
Practice Address - Street 1:2600 GLASGOW AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5703
Practice Address - Country:US
Practice Address - Phone:302-731-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000485111N00000X
DELG-0012393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE11535954OtherCAQH