MEDICARE: CHRISTINA 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1629549290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ROMAN

Provider Business Mailing Address
First Line	:	6810 LONG MEADOW CIR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 LONG MEADOW CIR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6177
Country	:	US
Telephone Number	:	904-874-6352
Fax Number	:

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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Directions to “ CHRISTINA ROMAN ” Practice Location

Language	Start Address	Practice Location

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