Provider Demographics
NPI:1477106870
Name:SERRANO ROSA, JOSE O (MS, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:O
Last Name:SERRANO ROSA
Suffix:
Gender:M
Credentials:MS, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 GENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-7279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8431 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3729
Practice Address - Country:US
Practice Address - Phone:813-993-1375
Practice Address - Fax:813-990-0222
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2024-11-26
Deactivation Date:2024-03-23
Deactivation Code:
Reactivation Date:2024-10-02
Provider Licenses
StateLicense IDTaxonomies
PR90073163W00000X
FLRN9597608163W00000X
NY804384163W00000X
PR005303363LP0808X
NYF406295-01363LP0808X
FLAPRN11034902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
363LP0808X.OtherPSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER (PMHNP)
163W00000XOtherREGISTERED NURSE