Provider Demographics
NPI:1639462310
Name:MASSEY, ROSE A (APRN)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:MASSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SUNFOREST DR
Mailing Address - Street 2:STE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-942-8900
Mailing Address - Fax:727-942-8989
Practice Address - Street 1:2122 ALT 19 STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5357
Practice Address - Country:US
Practice Address - Phone:727-942-8900
Practice Address - Fax:727-942-8989
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2892022363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005630300Medicaid
FA569XMedicare PIN