Healthcare Provider Details

I. General information

NPI: 1801420187
Provider Name (Legal Business Name): LAUREN TRACY ROSA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN TRACY KESACK

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W RIVER ST STE 8
PROVIDENCE RI
02904-2615
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-3000
  • Fax: 401-331-8110
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02268
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN02268
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: