Individual
PHYLLIS THERESA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NA
Contact information
Practice address
7406 FULLERTON ST STE 200, JACKSONVILLE, FL 32256-3597
(904) 538-0440
Mailing address
18320 NE 20TH CT, NORTH MIAMI BEACH, FL 33179-5010
(305) 979-0931
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HW806A
—
FL
Enumeration date
05/26/2017
Last updated
05/26/2017
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