Provider Demographics
NPI:1801420187
Name:ROSA, LAUREN TRACY (NP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TRACY
Last Name:ROSA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:TRACY
Other - Last Name:KESACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 RIDGELAND RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-4041
Mailing Address - Country:US
Mailing Address - Phone:401-714-5387
Mailing Address - Fax:
Practice Address - Street 1:3 RIDGELAND RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-4041
Practice Address - Country:US
Practice Address - Phone:401-714-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02268363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner