Healthcare Provider Details

I. General information

NPI: 1790503167
Provider Name (Legal Business Name): ALEXIS ROMINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E HIGHWAY 90
SIERRA VISTA AZ
85635-9110
US

IV. Provider business mailing address

2012 W CAVE COTTON LOOP
BENSON AZ
85602-6798
US

V. Phone/Fax

Practice location:
  • Phone: 520-263-2440
  • Fax:
Mailing address:
  • Phone: 520-221-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number315089
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: