Provider Demographics
NPI:1518021724
Name:ROGUSTA, SIAN AGERS (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SIAN
Middle Name:AGERS
Last Name:ROGUSTA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SIAN
Other - Middle Name:AGERS
Other - Last Name:GHOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:269-341-0982
Mailing Address - Fax:
Practice Address - Street 1:1580 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6827
Practice Address - Country:US
Practice Address - Phone:352-259-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518021724Medicaid
MI1801818752OtherBCBSM BRONSON
MI1518021724Medicaid