Provider Demographics
NPI:1245781624
Name:ROSA, VIVIAN (ARNP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:160 JFK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6632
Mailing Address - Country:US
Mailing Address - Phone:561-439-0961
Mailing Address - Fax:561-439-0963
Practice Address - Street 1:160 JFK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6632
Practice Address - Country:US
Practice Address - Phone:561-439-0961
Practice Address - Fax:561-439-0963
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1016172164W00000X
FLARNP9265468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse