Healthcare Provider Details

I. General information

NPI: 1598204422
Provider Name (Legal Business Name): ROSALIE NOCELLA MD, DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2017
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST FL 2
JACKSONVILLE FL
32209
US

IV. Provider business mailing address

653-1 W 8TH ST FL 2
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-2000
  • Fax:
Mailing address:
  • Phone: 904-244-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN23174
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME172007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: