Provider Demographics
NPI:1124707898
Name:ERNEST ROGE, ROSE MARIE (NP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:ERNEST ROGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 LAGUNA PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-0034
Mailing Address - Country:US
Mailing Address - Phone:786-487-2325
Mailing Address - Fax:
Practice Address - Street 1:10640 LAGUNA PLAINS DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-0034
Practice Address - Country:US
Practice Address - Phone:786-487-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily