Provider Demographics
NPI:1710498670
Name:ROSIC, ENIS (APRN, AGAC)
Entity Type:Individual
Prefix:MR
First Name:ENIS
Middle Name:
Last Name:ROSIC
Suffix:
Gender:M
Credentials:APRN, AGAC
Other - Prefix:MR
Other - First Name:ED
Other - Middle Name:
Other - Last Name:ROSIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-9140
Mailing Address - Fax:859-301-9141
Practice Address - Street 1:651 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5423
Practice Address - Country:US
Practice Address - Phone:859-301-9140
Practice Address - Fax:859-301-9141
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011521363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care