Provider Demographics
NPI:1023329646
Name:ROBERTS, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ROBERTS
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 1:4645 NW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5387
Mailing Address - Country:US
Mailing Address - Phone:754-273-0452
Mailing Address - Fax:
Practice Address - Street 1:6412 N UNIVERSITY DR
Practice Address - Street 2:SUITE #114
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4055
Practice Address - Country:US
Practice Address - Phone:954-726-6722
Practice Address - Fax:954-726-6723
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 70425376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide