Provider Demographics
NPI:1457392854
Name:RICCI, ROSEMARY ZARA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:ZARA
Last Name:RICCI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 ROBALO DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5229
Mailing Address - Country:US
Mailing Address - Phone:310-210-4771
Mailing Address - Fax:
Practice Address - Street 1:1875 ROBALO DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5229
Practice Address - Country:US
Practice Address - Phone:310-210-4771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9206151367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306344500Medicaid
G3512YMedicare ID - Type Unspecified