Provider Demographics
NPI:1184464885
Name:GOROSPE, REVELINE P (FNP)
Entity type:Individual
Prefix:MS
First Name:REVELINE
Middle Name:P
Last Name:GOROSPE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 N HERITAGE DR STE E
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5537
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:760-371-2288
Practice Address - Street 1:900 N HERITAGE DR STE E
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5537
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:760-371-2288
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95029594363LF0000X
AZ313634363LF0000X
CANP95029594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily