MEDICARE: SARA JANE ROSENBAUM CNM, WHNP-BC, DNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	APRN11000621	FL
2	367A00000X	Advanced Practice Midwife	APRN11000621	FL

General Provider Information

NPI Number	:	1902055213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JANE ROSENBAUM CNM, WHNP-BC, DNP

Provider Business Mailing Address
First Line	:	PO BOX 25317
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-5317
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	1411 S 14TH ST STE D
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3092
Country	:	US
Telephone Number	:	904-321-0064
Fax Number	:	904-491-3113

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/11/2024

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