Provider Demographics
NPI:1811512973
Name:ROMULUS, LANY TABITA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:LANY
Middle Name:TABITA
Last Name:ROMULUS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 NW BAYNARD DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3604
Mailing Address - Country:US
Mailing Address - Phone:772-200-1920
Mailing Address - Fax:
Practice Address - Street 1:5991 NW BAYNARD DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3604
Practice Address - Country:US
Practice Address - Phone:772-200-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9532921163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health