Healthcare Provider Details

I. General information

NPI: 1558178236
Provider Name (Legal Business Name): NATHANIEL ROKOSZ DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

221 DAYMARK LN
SAINT AUGUSTINE FL
32095-7630
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number155036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: