Healthcare Provider Details

I. General information

NPI: 1942478656
Provider Name (Legal Business Name): ROSE CALI BRADWELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSE CALI ST. JACQUES PA

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 305-466-9988
  • Fax: 305-466-9989
Mailing address:
  • Phone: 800-226-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102203
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: