Provider Demographics
NPI:1467129304
Name:COMPLECARE WELLNESS
Entity type:Organization
Organization Name:COMPLECARE WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC,FNP-BC
Authorized Official - Phone:954-866-0810
Mailing Address - Street 1:8801 W ATLANTIC BLVD # 773714
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7462
Mailing Address - Country:US
Mailing Address - Phone:954-866-0810
Mailing Address - Fax:877-552-0946
Practice Address - Street 1:9900 W SAMPLE RD STE 300
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4077
Practice Address - Country:US
Practice Address - Phone:954-866-0810
Practice Address - Fax:877-552-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty