Individual
MRS. JESSICA H ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
584 E BLUE ROCK WAY, VAIL, AZ 85641-2270
(813) 451-9254
Mailing address
584 E BLUE ROCK WAY, VAIL, AZ 85641-2270
(813) 451-9254
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
148950
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148950
LICENSE
AZ
Enumeration date
03/13/2020
Last updated
03/13/2020
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