Provider Demographics
NPI:1699958884
Name:RAY, ROSE MARTHA (ARNP)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARTHA
Last Name:RAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 W GRANADA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 N STONE ST STE D
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0824
Practice Address - Country:US
Practice Address - Phone:386-943-3270
Practice Address - Fax:386-822-9112
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2751082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 2751082OtherSTATE LICENSE