Provider Demographics
NPI:1720543275
Name:ROSE, CARRIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 FITZHUGH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1800
Mailing Address - Country:US
Mailing Address - Phone:804-288-5700
Mailing Address - Fax:
Practice Address - Street 1:5700 FITZHUGH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1800
Practice Address - Country:US
Practice Address - Phone:804-288-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177290208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation