Healthcare Provider Details

I. General information

NPI: 1508637919
Provider Name (Legal Business Name): LINA PATRICIA MOSQUERA-ROSALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JOHN F KENNEDY DR
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

3020 CONGRESS PARK DR APT 238
LAKE WORTH FL
33461-5240
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0353
  • Fax:
Mailing address:
  • Phone: 561-541-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: