Provider Demographics
NPI:1871011676
Name:ROSA, IVETTE M (BA)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:M
Last Name:ROSA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:IVETTE
Other - Middle Name:M
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1975 S JOHN YOUNG PKWY STE 203A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1975 S JOHN YOUNG PKWY STE 203A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0603
Practice Address - Country:US
Practice Address - Phone:407-791-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator