Provider Demographics
NPI:1740765130
Name:ST.ROSE, ALEXANDRIA DOLORES (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:DOLORES
Last Name:ST.ROSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 FOXTAIL PALM CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6845
Mailing Address - Country:US
Mailing Address - Phone:561-713-3772
Mailing Address - Fax:
Practice Address - Street 1:4640 HYPOLUXO RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7534
Practice Address - Country:US
Practice Address - Phone:561-296-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9370029363L00000X
FL11000472363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner