Provider Demographics
NPI:1790128791
Name:JAMES, ROSE FABIENNE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:FABIENNE
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:FABIENNE
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3910 NORTHDALE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1800
Mailing Address - Country:US
Mailing Address - Phone:813-570-6971
Mailing Address - Fax:
Practice Address - Street 1:3910 NORTHDALE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1800
Practice Address - Country:US
Practice Address - Phone:813-570-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139342208000000X
ALMD.33704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics