Provider Demographics
NPI:1871000513
Name:DALLA ROSA, JACQUELINE JHOVANA (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:JHOVANA
Last Name:DALLA ROSA
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DEVONSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4313
Mailing Address - Country:US
Mailing Address - Phone:786-385-9090
Mailing Address - Fax:
Practice Address - Street 1:6521 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2131
Practice Address - Country:US
Practice Address - Phone:954-941-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9335763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily