Healthcare Provider Details

I. General information

NPI: 1205867652
Provider Name (Legal Business Name): TINA M ROSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MAIN ST SUITE 3
ATTLEBORO MA
02703-1735
US

IV. Provider business mailing address

550N MAIN ST 3
ATTLEBORO MA
02703-1735
US

V. Phone/Fax

Practice location:
  • Phone: 508-699-7800
  • Fax: 508-699-7801
Mailing address:
  • Phone: 508-699-7800
  • Fax: 508-699-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number181386
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: