Provider Demographics
NPI:1104477553
Name:MCGHIE-ANDERSON, ROSE LAVINE (PHD, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:LAVINE
Last Name:MCGHIE-ANDERSON
Suffix:
Gender:F
Credentials:PHD, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12757 SW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5566
Mailing Address - Country:US
Mailing Address - Phone:954-663-8528
Mailing Address - Fax:
Practice Address - Street 1:7642 KISMET ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5949
Practice Address - Country:US
Practice Address - Phone:954-709-6545
Practice Address - Fax:954-369-4742
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily