Provider Demographics
NPI:1235270406
Name:ROSAL, TONI E (CRNP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:E
Last Name:ROSAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 KNOLL NORTH DR
Mailing Address - Street 2:STE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2368
Mailing Address - Country:US
Mailing Address - Phone:410-328-2302
Mailing Address - Fax:410-328-6956
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2302
Practice Address - Fax:410-328-2302
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR098072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0460OtherBC/BS REGIONAL
MD005402000Medicaid
MD005402000Medicaid