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NPI Code Detail

MEDICARE: NICOLE ROSSO PA-C

MEDICARE: NICOLE ROSSO PA-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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1295325132
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ROSSO PA-C
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2021
Last Update Date : 05/06/2026

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Directions to “ NICOLE ROSSO PA-C” Practice Location

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