MEDICARE: MRS. LISA SUZETTE ROSE DNP MSN ARNP MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11037928	FL

General Provider Information

NPI Number	:	1649079104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SUZETTE ROSE DNP MSN ARNP MBA

Provider Business Mailing Address
First Line	:	20380 SW 5TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-5028
Country	:	US
Telephone Number	:	305-915-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	20380 SW 5TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-5028
Country	:	US
Telephone Number	:	305-915-1217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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