Provider Demographics
NPI:1073953196
Name:ROMAN, TENIKA N (SA-C, LSA)
Entity Type:Individual
Prefix:
First Name:TENIKA
Middle Name:N
Last Name:ROMAN
Suffix:
Gender:F
Credentials:SA-C, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27609 PLEASURE RIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-1837
Mailing Address - Country:US
Mailing Address - Phone:813-482-2289
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:27609 PLEASURE RIDE LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-1837
Practice Address - Country:US
Practice Address - Phone:813-482-2289
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13191246ZC0007X, 364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative