Individual
NICOLE AGNES ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3615 S FLORIDA AVE STE 460, LAKELAND, FL 33803-4871
(863) 940-2091
Mailing address
4907 STONECREST DR, LAKELAND, FL 33813-2479
(813) 486-3376
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6414
FL
Other
Enumeration date
02/01/2024
Last updated
02/01/2024
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