Healthcare Provider Details

I. General information

NPI: 1811861404
Provider Name (Legal Business Name): SACRED ROSE CENTER FOR WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3564 AVALON PARK BLVD E STE 1-A742
ORLANDO FL
32828-7365
US

IV. Provider business mailing address

3564 AVALON PARK BLVD E STE 1-A742
ORLANDO FL
32828-7365
US

V. Phone/Fax

Practice location:
  • Phone: 321-386-2332
  • Fax: 320-207-9107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JASMINE LUCKETT-EPPS
Title or Position: OWNER/PROVIDER
Credential: PMHNP
Phone: 202-759-4214