Healthcare Provider Details

I. General information

NPI: 1326799537
Provider Name (Legal Business Name): SCARLETT ROSE COVID TESTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S HOSPITAL DR STE 15
PLANTATION FL
33317-2830
US

IV. Provider business mailing address

2733 NW 202ND LN
MIAMI GARDENS FL
33056-2132
US

V. Phone/Fax

Practice location:
  • Phone: 305-879-4782
  • Fax:
Mailing address:
  • Phone: 305-879-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAWNETTE E PATTERSON-LEWIS
Title or Position: CEO
Credential: APRN
Phone: 305-879-4782