Provider Demographics
NPI:1366703639
Name:ROMAN, AMBER E (CNM)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:E
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY OFFICE BLVD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6475
Mailing Address - Country:US
Mailing Address - Phone:850-324-5393
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY OFFICE BLVD BLDG 4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6475
Practice Address - Country:US
Practice Address - Phone:850-324-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020691176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoula