Provider Demographics
NPI:1144894304
Name:AMBROISE, ANNE ROSE
Entity type:Individual
Prefix:
First Name:ANNE ROSE
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 KATHY CT
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2446
Mailing Address - Country:US
Mailing Address - Phone:954-254-9321
Mailing Address - Fax:
Practice Address - Street 1:1314 SUMMIT RUN CIR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-4743
Practice Address - Country:US
Practice Address - Phone:954-254-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services