Provider Demographics
NPI:1740209857
Name:WHITE, MARIA ROSE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ROSE
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:ROSE
Other - Last Name:BOLOGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2660 WEST FAIRBANKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-898-2767
Mailing Address - Fax:321-248-3479
Practice Address - Street 1:2660 WEST FAIRBANKS AVENUE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:321-248-3479
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2675742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2675742OtherARNP LICENSE
FLP45362Medicare UPIN
FLY0343XMedicare ID - Type Unspecified