Provider Demographics
NPI:1023529161
Name:DESTINE, ROSE ANDREE (RN)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ANDREE
Last Name:DESTINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 N MILITARY TRL STE 112
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6030
Mailing Address - Country:US
Mailing Address - Phone:561-633-1404
Mailing Address - Fax:
Practice Address - Street 1:1489 N MILITARY TRL STE 112
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6030
Practice Address - Country:US
Practice Address - Phone:561-633-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9466371163W00000X
FL23838376J00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No163W00000XNursing Service ProvidersRegistered Nurse
No376J00000XNursing Service Related ProvidersHomemaker