Provider Demographics
NPI:1821121062
Name:ROSA, YVETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13902 N DALE MABRY HWY STE 134
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2441
Mailing Address - Country:US
Mailing Address - Phone:813-363-8964
Mailing Address - Fax:813-968-7999
Practice Address - Street 1:13902 N DALE MABRY HWY STE 134
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2441
Practice Address - Country:US
Practice Address - Phone:813-363-8964
Practice Address - Fax:813-968-7999
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55900OtherBLUE CROSS BLUE SHIELD