Provider Demographics
NPI:1831850551
Name:EWING, ROSE MARY (PA)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARY
Last Name:EWING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-5917
Mailing Address - Country:US
Mailing Address - Phone:954-812-6204
Mailing Address - Fax:
Practice Address - Street 1:555 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3500
Practice Address - Country:US
Practice Address - Phone:954-812-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102577363AM0700X, 261QP2300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care