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General NPI Number Information
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NPI Number | 1679206866
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Entity Type | Individual
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Provider Name | JACQUELINE C ROSA PA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2 MEDICAL CENTER DR STE 309
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1271
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Country | US
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Telephone | 413-794-8020
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Fax | 413-794-2165
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Provider Business Mailing Address
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Address Line | 280 CHESTNUT ST FL 2
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City | SPRINGFIELD
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State | MA
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Zip | 01199-1001
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Country | US
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Telephone | 413-794-5700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9480
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License Number State | MA
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