Healthcare Provider Details

I. General information

NPI: 1376203406
Provider Name (Legal Business Name): ALYSSA ROSALES APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 W SLAUGHTER LN STE 490
AUSTIN TX
78748-6208
US

IV. Provider business mailing address

2509 CAMPDEN DR
AUSTIN TX
78745-4839
US

V. Phone/Fax

Practice location:
  • Phone: 512-282-8967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1047224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: