Provider Demographics
NPI:1003377029
Name:ROSE, AMANDA A (APRN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:A
Last Name:ROSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:98 TERRA MANGO LOOP STE 12
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8515
Mailing Address - Country:US
Mailing Address - Phone:407-612-4007
Mailing Address - Fax:407-612-4017
Practice Address - Street 1:6290 LINTON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6409
Practice Address - Country:US
Practice Address - Phone:561-499-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001197363LP0200X
FL11001197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics