MEDICARE: LISA ANN ROSE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP1867772	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285643262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN ROSE NP-C

Provider Business Mailing Address
First Line	:	2724 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1020
Country	:	US
Telephone Number	:	727-796-2444
Fax Number	:	727-796-7653

Provider Business Practice Location Address
First Line	:	2724 PARK DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1020
Country	:	US
Telephone Number	:	727-796-2444
Fax Number	:	727-796-7653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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