Healthcare Provider Details

I. General information

NPI: 1740724061
Provider Name (Legal Business Name): ILDA ROSA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-3108
US

IV. Provider business mailing address

9125 BOUNDARY LN
PARMA OH
44130-5201
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2292
  • Fax: 216-736-7969
Mailing address:
  • Phone: 216-347-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: