Healthcare Provider Details

I. General information

NPI: 1326650219
Provider Name (Legal Business Name): NOLA ROMBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W MERRITT AVE
MERRITT ISLAND FL
32953-4761
US

IV. Provider business mailing address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2744
  • Fax: 321-350-0008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11015989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: