Provider Demographics
NPI:1962012799
Name:OKWANY, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:OKWANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6921 WOODCHASE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8400
Mailing Address - Country:US
Mailing Address - Phone:813-597-3223
Mailing Address - Fax:
Practice Address - Street 1:6921 WOODCHASE GLEN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8400
Practice Address - Country:US
Practice Address - Phone:813-597-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health