Provider Demographics
NPI:1841947488
Name:JAVAHERI, ROSE HAMIDEH
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:HAMIDEH
Last Name:JAVAHERI
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 1:110 W UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1139
Mailing Address - Country:US
Mailing Address - Phone:407-422-3790
Mailing Address - Fax:407-425-4358
Practice Address - Street 1:110 W UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1139
Practice Address - Country:US
Practice Address - Phone:407-422-3790
Practice Address - Fax:407-425-4358
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018455363LF0000X, 363LP0200X
FLAPRN11018455363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics