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General NPI Number Information
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NPI Number | 1801324454
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Entity Type | Individual
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Provider Name | PHYLLIS THERESA ROSE NA
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Gender | Female
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 7406 FULLERTON ST STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3597
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Country | US
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Telephone | 904-538-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 18320 NE 20TH CT
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-5010
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Country | US
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Telephone | 305-979-0931
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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 |
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License Number State | FL
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