Provider Demographics
NPI:1801778295
Name:ROSA, TERRA DEE ANN
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:DEE ANN
Last Name:ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:EDGERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:916-931-3270
Mailing Address - Fax:
Practice Address - Street 1:1716 HEARTNUT WAY
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326-9284
Practice Address - Country:US
Practice Address - Phone:209-247-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst