MEDICARE: YAIR GONZALEZ ROMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11046212	FL

General Provider Information

NPI Number	:	1356299754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIR GONZALEZ ROMAN

Provider Business Mailing Address
First Line	:	1020 LEISURE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1722
Country	:	US
Telephone Number	:	786-970-9535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 LEISURE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1722
Country	:	US
Telephone Number	:	786-970-9535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ YAIR GONZALEZ ROMAN ” Practice Location

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