Provider Demographics
NPI:1043087521
Name:RAMOS ROSADO, KEVIN M (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:RAMOS ROSADO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15348 MARGAUX DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-5041
Mailing Address - Country:US
Mailing Address - Phone:407-235-6467
Mailing Address - Fax:
Practice Address - Street 1:15348 MARGAUX DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-5041
Practice Address - Country:US
Practice Address - Phone:407-235-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty