Provider Demographics
NPI:1083043285
Name:FOWLIN, ROSINE (MA)
Entity Type:Individual
Prefix:
First Name:ROSINE
Middle Name:
Last Name:FOWLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROSINE
Other - Middle Name:
Other - Last Name:SIMONIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16539 LAKE BRIGADOON CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1146
Mailing Address - Country:US
Mailing Address - Phone:813-579-2212
Mailing Address - Fax:
Practice Address - Street 1:145 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4014
Practice Address - Country:US
Practice Address - Phone:863-619-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician