Provider Demographics
NPI:1073677902
Name:ROMAN, CARMEN E (RDN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6312
Mailing Address - Country:US
Mailing Address - Phone:407-315-3637
Mailing Address - Fax:407-358-3440
Practice Address - Street 1:217 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6312
Practice Address - Country:US
Practice Address - Phone:407-315-3637
Practice Address - Fax:407-358-3440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4180823OtherDRIVER'S LICENCE