Provider Demographics
NPI:1629775986
Name:ROSALES PINO, ROXANA ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:ELAINE
Last Name:ROSALES PINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3568
Mailing Address - Country:US
Mailing Address - Phone:305-492-3410
Mailing Address - Fax:
Practice Address - Street 1:899 W 79TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3568
Practice Address - Country:US
Practice Address - Phone:305-492-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFO1230474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily