Healthcare Provider Details

I. General information

NPI: 1891828422
Provider Name (Legal Business Name): JUDYANNE TENICA ROSS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 STRAND ST
FREDERIKSTED VI
00840-3533
US

IV. Provider business mailing address

516 STRAND ST
FREDERIKSTED VI
00840-3533
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-0260
  • Fax: 340-719-6276
Mailing address:
  • Phone: 340-772-0260
  • Fax: 340-719-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number5298
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: