Provider Demographics
NPI:1891167383
Name:ROMANO, NATALIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:MICHELLE
Last Name:ROMANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S BOULEVARD FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2629
Mailing Address - Country:US
Mailing Address - Phone:813-995-1775
Mailing Address - Fax:813-642-4877
Practice Address - Street 1:603 S BOULEVARD FL 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2629
Practice Address - Country:US
Practice Address - Phone:813-995-1775
Practice Address - Fax:813-642-4877
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003170699AMedicaid
FL016029500Medicaid
GA003170699AMedicaid