Provider Demographics
NPI:1538496237
Name:TIPPMANN, ROSEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:TIPPMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROSEANNE
Other - Middle Name:
Other - Last Name:FOGARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8470 KINGBIRD LOOP
Mailing Address - Street 2:UNIT 1050
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5769
Mailing Address - Country:US
Mailing Address - Phone:502-689-4098
Mailing Address - Fax:
Practice Address - Street 1:8470 KINGBIRD LOOP
Practice Address - Street 2:UNIT 1050
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5769
Practice Address - Country:US
Practice Address - Phone:502-689-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6319A367500000X
FLAPRN 9367343367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0516877Medicare Oscar/Certification
KY0516877Medicare PIN