MEDICARE: ARIANA ROOSEN

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	225700000X	Massage Therapist	MA96220	FL

General Provider Information

NPI Number	:	1629669296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANA ROOSEN

Provider Business Mailing Address
First Line	:	95162 BERMUDA DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8774
Country	:	US
Telephone Number	:	904-441-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 OCEAN BLVD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5262
Country	:	US
Telephone Number	:	904-247-7402
Fax Number	:

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

Provider Enumeration Date	:	01/27/2021
Last Update Date	:	01/27/2021

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Directions to “ ARIANA ROOSEN ” Practice Location

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