Provider Demographics
NPI:1952423063
Name:BRAULT, ROSE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:BRAULT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:PROF
Other - First Name:ROSE
Other - Middle Name:
Other - Last Name:BRAULT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, NP-C, CNS
Mailing Address - Street 1:2120 N SHAMROCK RD
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9428
Mailing Address - Country:US
Mailing Address - Phone:863-257-0775
Mailing Address - Fax:863-452-0820
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:SUITE B-4
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-314-8440
Practice Address - Fax:863-314-0845
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 916122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2561Medicare ID - Type Unspecified
FLS80843Medicare UPIN