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General NPI Number Information
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NPI Number | 1023578440
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Entity Type | Individual
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Provider Name | ROSE CARLA ROUSSEAU FNP-C, APRN
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 20200 W DIXIE HWY STE 1108
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City | AVENTURA
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State | FL
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Zip | 33180-1922
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Country | US
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Telephone | 305-949-6003
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Fax |
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Provider Business Mailing Address
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Address Line | 20200 W DIXIE HWY STE 1108
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City | AVENTURA
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State | FL
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Zip | 33180-1922
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Country | US
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Telephone | 305-949-6003
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Fax | 305-945-2483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11001838
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License Number State | FL
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