Healthcare Provider Details

I. General information

NPI: 1720543275
Provider Name (Legal Business Name): CARRIE ROSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 FITZHUGH AVE
RICHMOND VA
23226-1800
US

IV. Provider business mailing address

5700 FITZHUGH AVE
RICHMOND VA
23226-1800
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-5700
  • Fax:
Mailing address:
  • Phone: 804-288-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0024177290
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: