Provider Demographics
NPI:1922773589
Name:ROSA, OLGA LIDIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:LIDIA
Last Name:ROSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:OLGA
Other - Middle Name:LIDIA
Other - Last Name:ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:8589 SW 156TH PL APT 321
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1255
Mailing Address - Country:US
Mailing Address - Phone:786-315-0071
Mailing Address - Fax:
Practice Address - Street 1:8589 SW 156TH PL APT 321
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1255
Practice Address - Country:US
Practice Address - Phone:786-315-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010397363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care