Individual
ROSE IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
125 W COPELAND DR, ORLANDO, FL 32806-2101
(321) 841-7090
(321) 843-2267
Mailing address
125 W COPELAND DR, ORLANDO, FL 32806
(321) 841-7090
(321) 843-2267
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9089
MA
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA9119022
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124041500
—
FL
Enumeration date
09/19/2021
Last updated
10/16/2024
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