Provider Demographics
NPI:1801249552
Name:RAPHAEL, ROSELINE (DNP,FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:DNP,FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:877-552-0946
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9275102363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily