Individual
ROSA VINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 BERT RD APT F134, JACKSONVILLE, FL 32211
(912) 631-0158
Mailing address
900 BERT RD APT F134, JACKSONVILLE, FL 32211-5963
(912) 631-0158
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
322212421103
OH
376K00000X
Nurse's Aide
50175752
KY
376K00000X
Nurse's Aide
CNA14178582
GA
376K00000X
Nurse's Aide
Primary
CNA147782
FL
Other
Enumeration date
03/16/2016
Last updated
03/16/2016
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