Provider Demographics
NPI:1073222733
Name:FERNANDEZ DE LA ROSA, ODALMIS (APRN)
Entity Type:Individual
Prefix:
First Name:ODALMIS
Middle Name:
Last Name:FERNANDEZ DE LA ROSA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4259
Mailing Address - Country:US
Mailing Address - Phone:786-812-6294
Mailing Address - Fax:
Practice Address - Street 1:4244 SW 154TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4259
Practice Address - Country:US
Practice Address - Phone:786-812-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023023363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty