Healthcare Provider Details

I. General information

NPI: 1669307351
Provider Name (Legal Business Name): ANNELIESE ROSSER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

36 PINEHURST CIR
ORMOND BEACH FL
32174-7559
US

V. Phone/Fax

Practice location:
  • Phone: 386-425-4000
  • Fax:
Mailing address:
  • Phone: 352-428-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: