Provider Demographics
NPI:1801544689
Name:ROSE, LATRICIA CIERRA (FNP)
Entity type:Individual
Prefix:
First Name:LATRICIA
Middle Name:CIERRA
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LATRICIA
Other - Middle Name:CIERRA
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1423 DENISON CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-7133
Mailing Address - Country:US
Mailing Address - Phone:706-615-7858
Mailing Address - Fax:770-922-9366
Practice Address - Street 1:1423 DENISON CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-7133
Practice Address - Country:US
Practice Address - Phone:706-615-7858
Practice Address - Fax:770-922-9366
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2021186817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty