| Rose Family Healthcare, Llc | |
|
4400 E Highway 20 Ste 207 Niceville FL 32578-7700 | |
| (850) 806-2440 | |
| Not Available |
| Full Name | Rose Family Healthcare, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4400 E Highway 20 Ste 207, Niceville, Florida |
| Authorized Official Name and Position | Susan M Wagner (OWNER) |
| Authorized Official Contact | 8508062440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rose Family Healthcare, Llc 4400 E Highway 20 Ste 207 Niceville FL 32578-7700 Ph: (850) 806-2440 | Rose Family Healthcare, Llc 4400 E Highway 20 Ste 207 Niceville FL 32578-7700 Ph: (850) 806-2440 |
| NPI Number | 1033925342 |
|---|---|
| Provider Enumeration Date | 12/10/2024 |
| Last Update Date | 12/10/2024 |
| Medicare PECOS PAC ID | 8729515150 |
|---|---|
| Medicare Enrollment ID | O20241226001524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033925342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Susan M Wagner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811514722 PECOS PAC ID: 6709297062 Enrollment ID: I20241226001905 |
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