Provider Demographics
NPI:1336901594
Name:ROSE, JOSEPH ANDREW (BSN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:ROSE
Suffix:
Gender:M
Credentials:BSN, FNP-BC
Other - Prefix:MR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, FNP-BC
Mailing Address - Street 1:1117 SUNSET DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4080
Mailing Address - Country:US
Mailing Address - Phone:662-699-0171
Mailing Address - Fax:
Practice Address - Street 1:1117 SUNSET DR STE 101
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4080
Practice Address - Country:US
Practice Address - Phone:662-227-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSROSE-7L4909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily