Provider Demographics
NPI:1295186591
Name:ROSARIO, MAGALY OVALLES (FNP)
Entity Type:Individual
Prefix:
First Name:MAGALY
Middle Name:OVALLES
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3524
Mailing Address - Country:US
Mailing Address - Phone:407-616-4109
Mailing Address - Fax:
Practice Address - Street 1:5920 SW 68TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3524
Practice Address - Country:US
Practice Address - Phone:407-616-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9272711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse