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General NPI Number Information
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NPI Number | 1639951528
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Entity Type | Individual
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Provider Name | ROSA MARIA PORTILLO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 880 SW 145TH AVE STE 202
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-6171
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Country | US
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Telephone | 866-849-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 20TH AVE SW # 1
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City | MINOT
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State | ND
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Zip | 58701-6452
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Country | US
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Telephone | 469-583-0709
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200494
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11029002
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License Number State | FL
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