MEDICARE: ROSEMITA RENE GANDAHO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11035478	FL

General Provider Information

NPI Number	:	1396542981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMITA RENE GANDAHO APRN

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 ORIENTA AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5621
Country	:	US
Telephone Number	:	407-553-7710
Fax Number	:	866-445-1446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	04/14/2026

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