Healthcare Provider Details

I. General information

NPI: 1912077108
Provider Name (Legal Business Name): ROSE M GUILBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NW DUNN RD
FORT PIERCE FL
34981-4901
US

IV. Provider business mailing address

5000 NW DUNN RD
FORT PIERCE FL
34981-4901
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-4500
  • Fax: 772-403-1400
Mailing address:
  • Phone: 772-403-4500
  • Fax: 772-403-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number179871
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME61292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: