Healthcare Provider Details

I. General information

NPI: 1013248723
Provider Name (Legal Business Name): STACY LYNN ROSEBROOK APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

IV. Provider business mailing address

1008 PARADISE PKWY
POOLVILLE TX
76487-1529
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-3120
  • Fax:
Mailing address:
  • Phone: 682-521-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP118958
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number604225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: