Healthcare Provider Details

I. General information

NPI: 1346786142
Provider Name (Legal Business Name): ROSE L DELVA MD/MSN/FNP/APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 SW 180TH TER
SOUTHWEST RANCHES FL
33331-1604
US

IV. Provider business mailing address

6080 SW 180TH TER
SOUTHWEST RANCHES FL
33331-1604
US

V. Phone/Fax

Practice location:
  • Phone: 954-865-7548
  • Fax: 305-653-0590
Mailing address:
  • Phone: 954-865-7548
  • Fax: 305-653-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1699162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: