Provider Demographics
NPI:1174810659
Name:ROSA, JEZEL E (APRN)
Entity type:Individual
Prefix:
First Name:JEZEL
Middle Name:E
Last Name:ROSA
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:PO BOX 510591
Mailing Address - Street 2:
Mailing Address - City:KEY COLONY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33051-0591
Mailing Address - Country:US
Mailing Address - Phone:305-393-9466
Mailing Address - Fax:
Practice Address - Street 1:600 W OCEAN DR # 591
Practice Address - Street 2:
Practice Address - City:KEY COLONY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33051-2000
Practice Address - Country:US
Practice Address - Phone:786-751-2082
Practice Address - Fax:786-590-1944
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9386197163W00000X
FLAPRN11013721363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 9386197OtherRN LICENSE
FLPMHNP-BC2021032994OtherANCC
FLAPRN11013721OtherFLORIDA DEPARTMENT OF HEALTH