Provider Demographics
NPI:1427054311
Name:ROS, ROSANNA (APRN)
Entity type:Individual
Prefix:MS
First Name:ROSANNA
Middle Name:
Last Name:ROS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ROSANNA
Other - Middle Name:
Other - Last Name:RELANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2828 CROASDAILE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2505
Mailing Address - Country:US
Mailing Address - Phone:877-751-1157
Mailing Address - Fax:919-425-1596
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:305-302-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3259062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P28551Medicare UPIN