Provider Demographics
NPI:1821044918
Name:DELA ROSA, JOCELYN C (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:C
Last Name:DELA ROSA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:C
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR
Mailing Address - Street 2:STE 120
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:360-479-8022
Mailing Address - Fax:360-479-0108
Practice Address - Street 1:1225 CAMPBELL WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-479-8022
Practice Address - Fax:360-479-0108
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3006982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645649Medicaid
WAQ53383Medicare UPIN
WA8857848Medicare PIN