Provider Demographics
NPI:1205863677
Name:ROTELLA, ROSA MERCEDES (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MERCEDES
Last Name:ROTELLA
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 1:176 W PINTO COURT
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143
Mailing Address - Country:US
Mailing Address - Phone:203-448-9083
Mailing Address - Fax:
Practice Address - Street 1:564 W 9TH PLACE SUITE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-412-6344
Practice Address - Fax:480-827-5457
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003149363L00000X
AZRN178718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39918Medicare UPIN