Provider Demographics
NPI:1831491091
Name:AUSTIN, ROSA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:M
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 TIMBERLAKE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5401
Mailing Address - Country:US
Mailing Address - Phone:916-689-4111
Mailing Address - Fax:916-689-6620
Practice Address - Street 1:8110 TIMBERLAKE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5401
Practice Address - Country:US
Practice Address - Phone:916-689-4111
Practice Address - Fax:916-689-6620
Is Sole Proprietor?:No
Enumeration Date:2010-11-21
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01212889OtherRAILROAD MEDICARE PTAN
CAHD923ZMedicare UPIN