Provider Demographics
NPI:1649676594
Name:DELAROSA, FLORA
Entity type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:
Last Name:DELAROSA
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 1:7414 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1308
Mailing Address - Country:US
Mailing Address - Phone:907-444-0770
Mailing Address - Fax:
Practice Address - Street 1:7414 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1308
Practice Address - Country:US
Practice Address - Phone:907-444-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701191163W00000X
AKNUR-R 28089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7257761OtherDRIVER LICENSE