Healthcare Provider Details

I. General information

NPI: 1073222733
Provider Name (Legal Business Name): ODALMIS FERNANDEZ DE LA ROSA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW 27TH AVE STE 206
MIAMI FL
33135-4748
US

IV. Provider business mailing address

1250 SW 27TH AVE STE 206
MIAMI FL
33135-4748
US

V. Phone/Fax

Practice location:
  • Phone: 305-317-4082
  • Fax: 305-280-9984
Mailing address:
  • Phone: 305-317-4082
  • Fax: 305-280-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: