| Doctor Name: | JANE PRISCILLA ROACH |
| NPI Number: | 1063559292 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | R066995 |
| Business Practice Address: | 2191 Defense Hwy Suite 201 Crofton, MD - 211142931 |
| Business Phone Number: | 4104519091 |
| Business Fax Number: | 4104519094 |
| Mailing Address: | 2191 Defense Hwy, Suite 201 CROFTON |
| State: | MD |
| Postal Code: | 211142931 |
| Phone Number: | 4104519091 |
| Fax Number: | 4104519094 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 12/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | R066995 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |