Active NPI
Jordan Prosser Rose, FNP
- Family Nurse Practitioner
- Rohnert Park, CA
National Provider Identifier
1851658322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 21928
- Practice address
- 1701 E Cotati Ave
Student Health Center
Rohnert Park, CA 94928-3612 - Phone
- (707) 664-2921
- NPI assigned
- Apr 20, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | 775622 | CA | |
| Family Nurse Practitioner | 363LF0000X | 21928 | CA | Primary |
Addresses
Primary practice location
1701 E Cotati Ave
Student Health Center
Rohnert Park, CA 94928-3612
Mailing address
1701 E Cotati Ave
Student Health Center
Rohnert Park, CA 94928-3612
Phone (707) 664-2921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21928 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1851658322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 E COTATI AVE",
"address_2": "STUDENT HEALTH CENTER",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949283612",
"telephone_number": "707-664-2921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 E COTATI AVE",
"address_2": "STUDENT HEALTH CENTER",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949283612",
"telephone_number": "707-664-2921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "JORDAN",
"middle_name": "PROSSER",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-20",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "CA",
"license": "775622",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "21928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.