Healthcare Provider Details

I. General information

NPI: 1093836538
Provider Name (Legal Business Name): ROSEMARY ALVAN JAMES-WORSHIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 WILLIS AVE
DAYTONA BEACH FL
32114-2810
US

IV. Provider business mailing address

764 GREENWAY PL
DAYTONA BEACH FL
32114-3941
US

V. Phone/Fax

Practice location:
  • Phone: 386-236-3194
  • Fax: 386-236-3178
Mailing address:
  • Phone: 386-257-9386
  • Fax: 386-236-3178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN412471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: