Provider Demographics
NPI:1598067324
Name:LAGUARDIA, ROSE MARY (FNP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:LAGUARDIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:MARY
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9001 DIGGES RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-330-1112
Mailing Address - Fax:703-330-3113
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-330-1112
Practice Address - Fax:703-330-3113
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily