Provider Demographics
NPI:1710592035
Name:ROSE, JESSICA MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-2070
Mailing Address - Country:US
Mailing Address - Phone:423-339-9581
Mailing Address - Fax:
Practice Address - Street 1:102 DUNHILL PL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3885
Practice Address - Country:US
Practice Address - Phone:423-339-9581
Practice Address - Fax:423-472-0494
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28131363LF0000X
TN188781163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse