MEDICARE: JONNA ROSH DNP, APRN,AGACNP-BC

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	163W00000X	Registered Nurse	895873	TX
2	363LA2100X	Acute Care Nurse Practitioner	2024087951	TX
3	363LG0600X	Gerontology Nurse Practitioner	2024087951	TX
4	363L00000X	Nurse Practitioner	1193094	TX

General Provider Information

NPI Number	:	1871329219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONNA ROSH DNP, APRN,AGACNP-BC

Provider Business Mailing Address
First Line	:	129 EDINBURGH
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-5136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE STE 250
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4828
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	05/16/2025

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