Provider Demographics
NPI:1598017972
Name:KINGMAN, ROANNA LYNN (ARNP, NP-C)
Entity Type:Individual
Prefix:
First Name:ROANNA
Middle Name:LYNN
Last Name:KINGMAN
Suffix:
Gender:F
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7801
Mailing Address - Country:US
Mailing Address - Phone:561-968-9805
Mailing Address - Fax:
Practice Address - Street 1:2055 MILITARY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-427-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily