Basic Information
Provider Information
NPI: 1851894364
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAVARRA
FirstName: ROSA
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6101 BLUE LAGOON DR STE 200
Address2:  
City: MIAMI
State: FL
PostalCode: 331263168
CountryCode: US
TelephoneNumber: 3055002027
FaxNumber: 3055002155
Practice Location
Address1: 6221 N FEDERAL HWY
Address2:  
City: FT LAUDERDALE
State: FL
PostalCode: 333081903
CountryCode: US
TelephoneNumber: 9544911686
FaxNumber: 8669812760
Other Information
ProviderEnumerationDate: 03/11/2018
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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