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General NPI Number Information
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NPI Number | 1831075928
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Entity Type | Individual
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Provider Name | LIUT IVON DE LA ROSA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 6802 W HILLSBOROUGH AVE STE 4
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City | TAMPA
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State | FL
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Zip | 33634-5004
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Country | US
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Telephone | 813-807-0264
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 W HILLSBOROUGH AVE STE 4
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City | TAMPA
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State | FL
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Zip | 33634-5004
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Country | US
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Telephone | 813-270-5227
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Fax | 813-270-5227
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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 | 11041660
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License Number State | FL
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