Provider Demographics
NPI:1083849590
Name:ROSATI, ANITA J
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:J
Last Name:ROSATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1722
Mailing Address - Country:US
Mailing Address - Phone:904-813-4834
Mailing Address - Fax:904-280-5247
Practice Address - Street 1:16 MARLIN AVE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1722
Practice Address - Country:US
Practice Address - Phone:904-813-4834
Practice Address - Fax:904-280-5247
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687830096Medicaid