Provider Demographics
NPI:1386601284
Name:ROSARIO, AILEEN EDITH (MD)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:EDITH
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:863-215-6639
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:521 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4501
Practice Address - Country:US
Practice Address - Phone:407-556-6222
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13786208D00000X
FLACN1091208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20592Medicare ID - Type UnspecifiedPROVIDER
PRH55670Medicare UPIN