Provider Demographics
NPI:1447303672
Name:EXANTUS, ROSEMOND J (PA)
Entity type:Individual
Prefix:
First Name:ROSEMOND
Middle Name:J
Last Name:EXANTUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1650
Mailing Address - Country:US
Mailing Address - Phone:561-531-3752
Mailing Address - Fax:561-531-3752
Practice Address - Street 1:3555 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1650
Practice Address - Country:US
Practice Address - Phone:561-531-3752
Practice Address - Fax:561-531-3752
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant