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General NPI Number Information
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NPI Number | 1083075220
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Entity Type | Individual
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Provider Name | ROSA VINES
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Gender | Female
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 900 BERT RD APT F134
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City | JACKSONVILLE
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State | FL
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Zip | 32211
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Country | US
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Telephone | 912-631-0158
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Fax |
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Provider Business Mailing Address
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Address Line | 900 BERT RD APT F134
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5963
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Country | US
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Telephone | 912-631-0158
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 50175752
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA147782
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 322212421103
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA14178582
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License Number State | GA
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