Provider Demographics
NPI:1770269631
Name:ROSTOLLAN, STEPHANIE (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROSTOLLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 MORROW STREET SUITE D
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4324
Mailing Address - Country:US
Mailing Address - Phone:479-385-2444
Mailing Address - Fax:479-385-2445
Practice Address - Street 1:403 MORROW STREET SUITE D
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4324
Practice Address - Country:US
Practice Address - Phone:479-437-6080
Practice Address - Fax:479-437-6079
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily