Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jordan Rose

Individual provider Registered Nurse · NPI 1164095964

Jordan Rose is a Nurse Practitioner in Santa Rosa, California. Qualified in 2023, 3 years ago. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2021
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1287 Fulton Rd
Santa Rosa, CA 95401-4923
Phone: (707) 800-7700
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95025794 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 95224646 (CA)

Record details

NPI number1164095964
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 20, 2021
Last updated in NPPESJune 26, 2024
Certification dateJune 26, 2024
Mailing addressPo Box 464, Mill Valley, CA 94942-0464

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations5 on file with Medicare

Other providers in Santa Rosa