Provider Demographics
NPI:1366933863
Name:ROMAN, YOLISA TIFFANY (APRN)
Entity type:Individual
Prefix:
First Name:YOLISA
Middle Name:TIFFANY
Last Name:ROMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 NW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-6756
Mailing Address - Country:US
Mailing Address - Phone:239-770-7263
Mailing Address - Fax:
Practice Address - Street 1:1407 VISCAYA PKWY STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6200
Practice Address - Country:US
Practice Address - Phone:239-772-0111
Practice Address - Fax:239-772-0267
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FL9596332163W00000X
FL11034613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse