Provider Demographics
NPI:1366619215
Name:ANDERSON, ROSE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1616
Mailing Address - Country:US
Mailing Address - Phone:305-577-4840
Mailing Address - Fax:305-373-7431
Practice Address - Street 1:336 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1616
Practice Address - Country:US
Practice Address - Phone:305-577-4840
Practice Address - Fax:305-373-7431
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1201762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301406100Medicaid
FLP43145Medicare UPIN
FLE3647WMedicare PIN