Healthcare Provider Details

I. General information

NPI: 1366933863
Provider Name (Legal Business Name): YOLISA TIFFANY ROMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 VISCAYA PKWY STE 2
CAPE CORAL FL
33990-6200
US

IV. Provider business mailing address

2914 NW 5TH AVE
CAPE CORAL FL
33993-6756
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0111
  • Fax: 239-772-0267
Mailing address:
  • Phone: 239-770-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9596332
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: