Provider Demographics
NPI:1023777869
Name:ROSA, PEGGY EDITH
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:EDITH
Last Name:ROSA
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 1:10424 WINWICK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7116
Mailing Address - Country:US
Mailing Address - Phone:787-564-9900
Mailing Address - Fax:
Practice Address - Street 1:10424 WINWICK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7116
Practice Address - Country:US
Practice Address - Phone:787-564-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider