Individual
MERRY J ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
207 PARK PLACE BLVD STE 2, KISSIMMEE, FL 34741-2373
(407) 870-5050
(407) 870-7609
Mailing address
1401 ILLINOIS AVE, SAINT CLOUD, FL 34769-4557
(407) 252-6314
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5228549
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN5228549
LPN LICENSE
FL
Enumeration date
02/16/2018
Last updated
02/16/2018
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