Healthcare Provider Details

I. General information

NPI: 1053132449
Provider Name (Legal Business Name): STACI NICOLE ROSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DR STE 202
SAFETY HARBOR FL
34695-6604
US

IV. Provider business mailing address

3232 BROOKSIDE CT
TARPON SPGS FL
34688-9224
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-6246
  • Fax:
Mailing address:
  • Phone: 860-336-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11036027
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: