Provider Demographics
NPI:1285017780
Name:ROSE, MIRIAM MICHAEL (FNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MICHAEL
Last Name:ROSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2801
Mailing Address - Country:US
Mailing Address - Phone:615-329-4182
Mailing Address - Fax:615-327-9399
Practice Address - Street 1:1233 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2801
Practice Address - Country:US
Practice Address - Phone:615-329-4182
Practice Address - Fax:615-327-9399
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0083151OtherBLUE CROSS
TN3036819Medicaid
TN0083151OtherBLUE CROSS
TNC64619Medicare UPIN