MEDICARE: LYNN ROOSA CNP

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	163W00000X	Registered Nurse	RN044558	AZ

General Provider Information

NPI Number	:	1649270851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN ROOSA CNP

Provider Business Mailing Address
First Line	:	2550 E GUADALUPE RD
Second Line	:	#109
City	:	GILBERT
State	:	AZ
Zip	:	85234-5114
Country	:	US
Telephone Number	:	480-505-4258
Fax Number	:	480-505-3689

Provider Business Practice Location Address
First Line	:	6301 S MCCLINTOCK DR
Second Line	:	#215
City	:	TEMPE
State	:	AZ
Zip	:	85283-3394
Country	:	US
Telephone Number	:	480-820-6657
Fax Number	:	480-820-0803

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/14/2025

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