MEDICARE: LISA MICHELLE ROSSBACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LS0200X	School Nurse Practitioner	RN9287905	FL
2	363L00000X	Nurse Practitioner	4704264456	MI

General Provider Information

NPI Number	:	1053146225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELLE ROSSBACH

Provider Business Mailing Address
First Line	:	1526 DEVONSHIRE DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-4375
Country	:	US
Telephone Number	:	248-854-1554
Fax Number	:

Provider Business Practice Location Address
First Line	:	11400 4TH ST N APT 604
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-2928
Country	:	US
Telephone Number	:	248-854-1554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	12/29/2024

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Directions to “ LISA MICHELLE ROSSBACH ” Practice Location

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