Provider Demographics
NPI:1134554876
Name:ROMAN, AMBER NICOLE FOGARTY (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:NICOLE FOGARTY
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5632
Mailing Address - Country:US
Mailing Address - Phone:813-591-5702
Mailing Address - Fax:813-642-4594
Practice Address - Street 1:3109 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5632
Practice Address - Country:US
Practice Address - Phone:813-591-5702
Practice Address - Fax:813-642-4594
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor