Healthcare Provider Details

I. General information

NPI: 1245884360
Provider Name (Legal Business Name): ROSE VERLANDE THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 BOREN DR STE 100
OCOEE FL
34761-2986
US

IV. Provider business mailing address

PO BOX 491000
LEESBURG FL
34749-1000
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-2715
  • Fax: 407-614-2741
Mailing address:
  • Phone: 352-315-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001183
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11001183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: