Healthcare Provider Details

I. General information

NPI: 1477632271
Provider Name (Legal Business Name): WARREN LEE ROSE II RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

3612 S BEACH DR
TAMPA FL
33629-8223
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax: 813-979-3606
Mailing address:
  • Phone: 813-972-2000
  • Fax: 813-979-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberTTOOO1515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: