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General NPI Number Information
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NPI Number | 1972068708
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Entity Type | Individual
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Provider Name | ROSA DAISY MAYTIN APRN
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Gender | Female
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 1100 CESERY BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5674
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Country | US
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Telephone | 904-551-5884
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Fax |
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Provider Business Mailing Address
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Address Line | 12171 SW 268TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33032-8001
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Country | US
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Telephone | 305-278-0200
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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 | APRN11001051
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License Number State | FL
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