Healthcare Provider Details

I. General information

NPI: 1578720165
Provider Name (Legal Business Name): ROSA ENIS NEGRON-MUNOZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S FLORIDA AVE STE 33
LAKELAND FL
33813-3312
US

IV. Provider business mailing address

6700 S FLORIDA AVE STE 33
LAKELAND FL
33813-3312
US

V. Phone/Fax

Practice location:
  • Phone: 863-450-3067
  • Fax: 863-337-4123
Mailing address:
  • Phone: 863-450-3067
  • Fax: 863-337-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME111271
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15448
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME111271
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME111271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: