Healthcare Provider Details

I. General information

NPI: 1801372628
Provider Name (Legal Business Name): ROSA WOODRUFF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HOBBS RD
AUBURNDALE FL
33823-4644
US

IV. Provider business mailing address

PO BOX 850
WHITE CLOUD MI
49349-0850
US

V. Phone/Fax

Practice location:
  • Phone: 863-965-5400
  • Fax: 863-965-3739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704292432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: