Provider Demographics
NPI:1104417708
Name:HERNANDEZ ROMAN, MICHELLE ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGEL
Last Name:HERNANDEZ ROMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANGEL
Other - Last Name:HERNANDEZ ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2707 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9406
Mailing Address - Country:US
Mailing Address - Phone:803-366-4157
Mailing Address - Fax:
Practice Address - Street 1:2707 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9406
Practice Address - Country:US
Practice Address - Phone:803-366-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003908363LF0000X
SC24147363LF0000X
MA10031433363LF0000X
NJ26NJ15415800363LF0000X
ND203110363LF0000X
OH0040460363LF0000X
NH11531023363LF0000X
DELG-0013308363LF0000X
CT12.015197363LF0000X
FL11041505363LF0000X
KS5384712022363LF0000X
NC02354363LF0000X
MD008048363LF0000X
KY4044850363LF0000X
ME251452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily