Provider Demographics
NPI:1174912539
Name:ROZMAN, JACQUELINE NATASHA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:NATASHA
Last Name:ROZMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:NATASHA
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3008 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4241
Mailing Address - Country:US
Mailing Address - Phone:912-265-2142
Mailing Address - Fax:912-265-0530
Practice Address - Street 1:3008 E PARK AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4241
Practice Address - Country:US
Practice Address - Phone:912-265-2142
Practice Address - Fax:912-265-0530
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN200773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner