Provider Demographics
NPI:1720267859
Name:ROMANO, LISA CHRISTINE (APN,C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:ROMANO
Suffix:
Gender:F
Credentials:APN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9888
Mailing Address - Fax:239-343-9868
Practice Address - Street 1:4751 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1317
Practice Address - Country:US
Practice Address - Phone:239-343-9888
Practice Address - Fax:239-343-9868
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09047900363LP0200X
FLAPRN11004985363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111976400Medicaid