Provider Demographics
NPI:1467682310
Name:ROBERTSON, MARY ROSE (ARNP-C MSN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ROSE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:ARNP-C MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 INGRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4336
Mailing Address - Country:US
Mailing Address - Phone:863-421-6565
Mailing Address - Fax:863-421-7474
Practice Address - Street 1:900 INGRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4336
Practice Address - Country:US
Practice Address - Phone:863-421-6565
Practice Address - Fax:863-421-7474
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9253787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9253787OtherLICENSE NUMBER
FLCW952ZOtherMEDICARE PROVIDER NUMBER
FLDC8324OtherRAILROAD MEDICARE