Provider Demographics
NPI:1174053805
Name:DAVIS, ROSE MARY (CNA, HHA)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 REFLECTIONS CIR APT 211
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6663
Mailing Address - Country:US
Mailing Address - Phone:321-271-8303
Mailing Address - Fax:
Practice Address - Street 1:830 REFLECTIONS CIR APT 211
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6663
Practice Address - Country:US
Practice Address - Phone:321-271-8303
Practice Address - Fax:321-271-8303
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144755117OtherNPI