Provider Demographics
NPI:1073877171
Name:ROSS, REGINA DENISE (ACNP-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:DENISE
Last Name:ROSS
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106B RALSTON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3390
Mailing Address - Country:US
Mailing Address - Phone:609-670-9730
Mailing Address - Fax:
Practice Address - Street 1:1500 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4067
Practice Address - Country:US
Practice Address - Phone:215-606-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011804363LA2100X
NJ26NJ00366600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care