Provider Demographics
NPI:1790912483
Name:DAVENPORT, ROSEMARY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:DAVENPORT
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 1:3542 S UNIVERSITY DR
Mailing Address - Street 2:SUITE #3542
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2003
Mailing Address - Country:US
Mailing Address - Phone:954-383-6065
Mailing Address - Fax:954-262-3236
Practice Address - Street 1:3542 S UNIVERSITY DR
Practice Address - Street 2:SUITE #3542
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2003
Practice Address - Country:US
Practice Address - Phone:954-262-1804
Practice Address - Fax:954-262-3236
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3084542363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology