Provider Demographics
NPI:1093512626
Name:TAVERA ROSARIO, KARL ENGELS (SA-C)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:ENGELS
Last Name:TAVERA ROSARIO
Suffix:
Gender:
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 PINE RIDGE CIR W APT C2
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-6407
Mailing Address - Country:US
Mailing Address - Phone:347-227-5767
Mailing Address - Fax:
Practice Address - Street 1:1258 PINE RIDGE CIR W APT C2
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-6407
Practice Address - Country:US
Practice Address - Phone:347-227-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-177246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant