Provider Demographics
NPI:1316472129
Name:POVIONES GARBALOSA, ROSA MARIA (APRN)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:POVIONES GARBALOSA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20230 NW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1335
Mailing Address - Country:US
Mailing Address - Phone:786-394-0811
Mailing Address - Fax:
Practice Address - Street 1:11760 BIRD RD STE 539
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8100
Practice Address - Country:US
Practice Address - Phone:305-228-6200
Practice Address - Fax:305-228-1314
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9309698363LF0000X
FLAPRN9309698363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily