JORDAN ROSE NPI 1164095964

NPI Information

  • NPI: 1164095964
  • Provider Name: JORDAN ROSE
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1287 FULTON RD
    SANTA ROSA, CA
    ZIP 95401
  • Phone: (707) 800-7700

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NPI Details

Jordan Rose is a psychiatric/mental health nurse practitioner in Santa Rosa, CA. Jordan Rose NPI is 1164095964. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1287 FULTON RD
SANTA ROSA, CA
ZIP 95401-923
Phone: (707) 800-7700

The NPI 1164095964 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/20/2021 and was last updated on 6/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered Nurse95224646CALIFORNIANo
2363LP0808XNurse PractitionerPsychiatric/Mental Health95025794CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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