Provider Demographics
NPI:1083196844
Name:ROSA, JACQUELINE FREITAS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FREITAS
Last Name:ROSA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:827 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4128
Practice Address - Country:US
Practice Address - Phone:508-636-5101
Practice Address - Fax:508-636-3651
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01805363LF0000X
MARN2305472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily