Healthcare Provider Details

I. General information

NPI: 1972210508
Provider Name (Legal Business Name): PEARL ROSE WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DR STE 132
BRANDON FL
33511-0802
US

IV. Provider business mailing address

1463 OAKFIELD DR STE 132
BRANDON FL
33511-0802
US

V. Phone/Fax

Practice location:
  • Phone: 813-409-3425
  • Fax: 813-409-3427
Mailing address:
  • Phone: 813-409-3425
  • Fax: 813-409-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: EDNA CARRASCO
Title or Position: PRESIDENT/ OPERATION MANAGER
Credential:
Phone: 813-409-3425