Provider Demographics
NPI:1720421308
Name:ROSE, JOHN ALLEN (RN, LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:ROSE
Suffix:
Gender:M
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 TOWN PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6216
Mailing Address - Country:US
Mailing Address - Phone:407-590-6836
Mailing Address - Fax:407-695-0069
Practice Address - Street 1:2006 TOWN PLAZA CT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6216
Practice Address - Country:US
Practice Address - Phone:407-590-6836
Practice Address - Fax:407-695-0069
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9330688163W00000X
FLMA56728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse