Provider Demographics
NPI:1053132449
Name:ROSEN, STACI NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:NICOLE
Last Name:ROSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:TARPON SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-9224
Mailing Address - Country:US
Mailing Address - Phone:860-336-6947
Mailing Address - Fax:
Practice Address - Street 1:1840 MEASE DR STE 202
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6604
Practice Address - Country:US
Practice Address - Phone:727-725-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036027363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty