Provider Demographics
NPI:1780674614
Name:DEROSA, BARBARA JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:DEROSA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 LEWIS LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9494
Mailing Address - Country:US
Mailing Address - Phone:859-384-1918
Mailing Address - Fax:
Practice Address - Street 1:7505 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1513
Practice Address - Country:US
Practice Address - Phone:859-363-2060
Practice Address - Fax:859-647-3594
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1078367/3501P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily