Provider Demographics
NPI:1972356061
Name:DEEN, ROXANN ELAINE (FNP-C)
Entity type:Individual
Prefix:
First Name:ROXANN
Middle Name:ELAINE
Last Name:DEEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 5
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8213
Mailing Address - Country:US
Mailing Address - Phone:229-386-4300
Mailing Address - Fax:229-386-8300
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 5
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8213
Practice Address - Country:US
Practice Address - Phone:229-386-4300
Practice Address - Fax:229-386-8300
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty