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General NPI Number Information
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NPI Number | 1669267563
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Entity Type | Individual
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Provider Name | MARISSA DE LA ROSA APRN
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Gender | Female
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 815 NW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33126-2018
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Country | US
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Telephone | 305-646-9644
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Fax |
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Provider Business Mailing Address
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Address Line | 901 S PARK RD APT 304
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8753
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Country | US
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Telephone | 786-266-0006
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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 | 11038730
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License Number State | FL
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