Provider Demographics
NPI:1356906598
Name:ROSA, HEATHER TIFFANY I (CRNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:TIFFANY
Last Name:ROSA
Suffix:I
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:511 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5731
Mailing Address - Country:US
Mailing Address - Phone:570-714-3333
Mailing Address - Fax:570-338-3993
Practice Address - Street 1:511 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5731
Practice Address - Country:US
Practice Address - Phone:570-714-3333
Practice Address - Fax:570-338-3993
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily