MEDICARE: DR. ROSALIE NOCELLA MD, DDS

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	ME172007	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN23174	FL

General Provider Information

NPI Number	:	1598204422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALIE NOCELLA MD, DDS

Provider Business Mailing Address
First Line	:	653-1 W 8TH ST FL 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-244-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	653-1 W 8TH ST FL 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209
Country	:	US
Telephone Number	:	904-244-2000
Fax Number	:

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

Provider Enumeration Date	:	02/12/2017
Last Update Date	:	02/10/2026

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