Provider Demographics
NPI:1639709876
Name:NINVALLE, ROSLYN (LNHA)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:
Last Name:NINVALLE
Suffix:
Gender:F
Credentials:LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 DOVE VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-6821
Mailing Address - Country:US
Mailing Address - Phone:347-661-5241
Mailing Address - Fax:
Practice Address - Street 1:8921 DOVE VALLEY WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-6821
Practice Address - Country:US
Practice Address - Phone:347-661-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-09-16
Deactivation Date:2020-09-08
Deactivation Code:
Reactivation Date:2020-09-16
Provider Licenses
StateLicense IDTaxonomies
FL2363888376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker