Healthcare Provider Details

I. General information

NPI: 1932035714
Provider Name (Legal Business Name): JESSICA L ROSALBO ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 WINDSOR CT
STATEN ISLAND NY
10314-4540
US

IV. Provider business mailing address

26 WINDSOR CT
STATEN ISLAND NY
10314-4540
US

V. Phone/Fax

Practice location:
  • Phone: 718-608-4061
  • Fax:
Mailing address:
  • Phone: 718-608-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number764326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: