Healthcare Provider Details

I. General information

NPI: 1275684144
Provider Name (Legal Business Name): ROSAIRE LAINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSAIRE LAINE ANP-BC

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 HEMPSTEAD TPKE
EAST MEADOW NY
11554-2030
US

IV. Provider business mailing address

10452 NW 48TH MNR
CORAL SPRINGS FL
33076-1730
US

V. Phone/Fax

Practice location:
  • Phone: 516-273-0163
  • Fax:
Mailing address:
  • Phone: 516-273-0163
  • Fax: 866-697-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11010650
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: