Provider Demographics
NPI:1225865793
Name:TAGARO, ROSAVILLA ANUTA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ROSAVILLA
Middle Name:ANUTA
Last Name:TAGARO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44839 DUSTY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7447
Mailing Address - Country:US
Mailing Address - Phone:661-483-8096
Mailing Address - Fax:
Practice Address - Street 1:44839 DUSTY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7447
Practice Address - Country:US
Practice Address - Phone:661-483-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732675163WC0400X
CA95032105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management