Healthcare Provider Details

I. General information

NPI: 1497177513
Provider Name (Legal Business Name): ROSA A. DRISCOLL RN, BSN, M.A., NE-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

12 MANALAPAN WOODS DR
MANALAPAN NJ
07726-4210
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 732-546-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number26NR08127600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: