Provider Demographics
NPI:1255012399
Name:AMBROISE, ROSE CARLINE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:CARLINE
Last Name:AMBROISE
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 1:16602 COVE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3290
Mailing Address - Country:US
Mailing Address - Phone:954-682-7076
Mailing Address - Fax:
Practice Address - Street 1:16602 COVE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-3290
Practice Address - Country:US
Practice Address - Phone:954-682-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty