Provider Demographics
NPI:1366840290
Name:ROSE, AUTUMN JOY (CRNA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:JOY
Last Name:ROSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ULMERTON RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2300
Mailing Address - Country:US
Mailing Address - Phone:727-210-8104
Mailing Address - Fax:954-616-3655
Practice Address - Street 1:1901 ULMERTON RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-2300
Practice Address - Country:US
Practice Address - Phone:727-210-8104
Practice Address - Fax:954-616-3655
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9204659163W00000X
FLARNP9204659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse