MEDICARE: ROMANA PETROVICH ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP3343202	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629073143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMANA PETROVICH ARNP

Provider Business Mailing Address
First Line	:	1324 LAKELAND HILLS BLVD
Second Line	:	ATTN: MEDICAL STAFF OFFICE
City	:	LAKELAND
State	:	FL
Zip	:	33805-4543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3050
Country	:	US
Telephone Number	:	863-284-6850
Fax Number	:	863-284-6853

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/20/2022

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