Provider Demographics
NPI:1538523238
Name:ROUSE, ANTOINE (RN)
Entity type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:
Last Name:ROUSE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18356 NW 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6304
Mailing Address - Country:US
Mailing Address - Phone:786-953-4612
Mailing Address - Fax:786-953-8534
Practice Address - Street 1:18356 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33055-6304
Practice Address - Country:US
Practice Address - Phone:786-953-4612
Practice Address - Fax:786-953-8534
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator