Healthcare Provider Details

I. General information

NPI: 1275356990
Provider Name (Legal Business Name): ROSA ANA CUETARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 LAKE WORTH RD # 100
GREENACRES FL
33463-3074
US

IV. Provider business mailing address

6135 LAKE WORTH RD # 100
GREENACRES FL
33463-3074
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: