Provider Demographics
NPI:1811571391
Name:ROSA, DEANNA MICHELE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MICHELE
Last Name:ROSA
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1890
Mailing Address - Country:US
Mailing Address - Phone:203-592-9544
Mailing Address - Fax:
Practice Address - Street 1:100 BEARD SAWMILL RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6150
Practice Address - Country:US
Practice Address - Phone:203-452-6240
Practice Address - Fax:203-225-7573
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9843363LP0200X
CT127965163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine