Provider Demographics
NPI:1760048342
Name:ROSE, CAMILLA (DNP)
Entity Type:Individual
Prefix:DR
First Name:CAMILLA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PAGE DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3438
Mailing Address - Country:US
Mailing Address - Phone:615-598-2460
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1712
Practice Address - Country:US
Practice Address - Phone:703-391-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-19
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29067367A00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife