Provider Demographics
NPI:1144620972
Name:SWILLEY, ROSELLE MARIE (NP-C, AGACNP-BC ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSELLE
Middle Name:MARIE
Last Name:SWILLEY
Suffix:
Gender:F
Credentials:NP-C, AGACNP-BC ARNP
Other - Prefix:MS
Other - First Name:ROSELLE
Other - Middle Name:MARIE
Other - Last Name:GOMONIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-934-0932
Mailing Address - Fax:850-934-0737
Practice Address - Street 1:2569 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3043
Practice Address - Country:US
Practice Address - Phone:850-934-0932
Practice Address - Fax:850-934-0737
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9173596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily