Healthcare Provider Details

I. General information

NPI: 1316546252
Provider Name (Legal Business Name): ROSEMANY RENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE INDIAN ST
STUART FL
34997-5688
US

IV. Provider business mailing address

855 SE STARFLOWER AVE
PORT SAINT LUCIE FL
34983-4638
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-4500
  • Fax:
Mailing address:
  • Phone: 772-646-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11005364
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: