Provider Demographics
NPI:1114460912
Name:CEAUSU, ROXANA LISSIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:LISSIE
Last Name:CEAUSU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 N PETERS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4923
Mailing Address - Country:US
Mailing Address - Phone:865-690-1255
Mailing Address - Fax:865-690-4583
Practice Address - Street 1:259 N PETERS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4923
Practice Address - Country:US
Practice Address - Phone:865-690-1255
Practice Address - Fax:865-690-4583
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily