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General NPI Number Information
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NPI Number | 1083826739
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Entity Type | Individual
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Provider Name | ROSHONDA EXANTUS MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FLORIDA A&M UNIVERSITY 1835 WAHNISH WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32303
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Country | US
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Telephone | 850-599-3720
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Fax |
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Provider Business Mailing Address
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Address Line | 18310 NW 21 AVE
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City | MIAMI
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State | FL
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Zip | 33056-2701
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Country | US
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Telephone | 786-395-0120
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL1753
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License Number State | FL
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