Healthcare Provider Details

I. General information

NPI: 1538892765
Provider Name (Legal Business Name): KRISTEN ROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 METROCENTER BLVD STE 300
ORLANDO FL
32835-7642
US

IV. Provider business mailing address

4620 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5884
US

V. Phone/Fax

Practice location:
  • Phone: 561-609-0770
  • Fax: 561-997-1246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: