Provider Demographics
NPI:1285643262
Name:ROSE, LISA ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1020
Mailing Address - Country:US
Mailing Address - Phone:727-796-2444
Mailing Address - Fax:727-796-7653
Practice Address - Street 1:2724 PARK DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1020
Practice Address - Country:US
Practice Address - Phone:727-796-2444
Practice Address - Fax:727-796-7653
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1867772363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health