Provider Demographics
NPI:1023578440
Name:ROUSSEAU, ROSE CARLA (FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CARLA
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 W DIXIE HWY STE 1108
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1922
Mailing Address - Country:US
Mailing Address - Phone:305-949-6003
Mailing Address - Fax:305-945-2483
Practice Address - Street 1:20200 W DIXIE HWY STE 1108
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1922
Practice Address - Country:US
Practice Address - Phone:305-949-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily