Provider Demographics
NPI:1831991314
Name:BOYETTE, ROXEANNA R
Entity type:Individual
Prefix:
First Name:ROXEANNA
Middle Name:R
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROXEANNA
Other - Middle Name:
Other - Last Name:RIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:475 W TOWN PL STE 105
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3649
Mailing Address - Country:US
Mailing Address - Phone:904-680-7328
Mailing Address - Fax:
Practice Address - Street 1:475 W TOWN PL STE 105
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3649
Practice Address - Country:US
Practice Address - Phone:904-680-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140014225700000X
FLMA140139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist