Provider Demographics
NPI:1205487063
Name:CELESTIN-OBAS, ROSE-ESTELLE TANIA (AGACNP)
Entity type:Individual
Prefix:
First Name:ROSE-ESTELLE
Middle Name:TANIA
Last Name:CELESTIN-OBAS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NE 214TH ST STE 809
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1270
Mailing Address - Country:US
Mailing Address - Phone:786-395-5481
Mailing Address - Fax:
Practice Address - Street 1:2820 NE 214TH ST STE 809
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1270
Practice Address - Country:US
Practice Address - Phone:754-600-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004895363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health