Individual
ROSE PACCIONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1651 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7564
(772) 398-1800
(772) 398-1815
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 781-2799
(772) 781-2716
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
ME135007
FL
207RP1001X
Pulmonary Disease Physician
ME135007
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86W4U
FLORIDA BLUE
FL
Enumeration date
04/01/2011
Last updated
10/14/2020
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