Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 11001197 | FL |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN11001197 | FL |
NPI | 1003377029 |
---|---|
Provider Name | Ms. Amanda A Rose |
First Address | Orlando, FL 32835-8515 |
Second Address | Orlando, FL 32835-8515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2019 |
Last Update Date | 26/11/2019 |