Provider Demographics
NPI:1336740448
Name:ROSALES CARRAZANA, JOSE ANGEL (FNP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:ROSALES CARRAZANA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 NE 135TH ST APT 339
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4476
Mailing Address - Country:US
Mailing Address - Phone:305-469-3819
Mailing Address - Fax:
Practice Address - Street 1:1255 NE 135TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4312
Practice Address - Country:US
Practice Address - Phone:305-891-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9498948163W00000X
FLF11200050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse