Provider Demographics
NPI:1285401018
Name:BERMEJO, ROSANNA
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:BERMEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 S BAYSHORE DR UNIT 908
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6071
Mailing Address - Country:US
Mailing Address - Phone:305-582-1629
Mailing Address - Fax:
Practice Address - Street 1:2601 SW 37TH AVE STE 603
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2750
Practice Address - Country:US
Practice Address - Phone:305-356-7402
Practice Address - Fax:305-356-7402
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12230004363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner