Provider Demographics
NPI:1841663424
Name:DAVIS, ROMANYNE ROSHAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ROMANYNE
Middle Name:ROSHAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ROMANYNE
Other - Middle Name:ROSHAN
Other - Last Name:NAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:4743 CLEMENS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8702
Mailing Address - Country:US
Mailing Address - Phone:561-255-2509
Mailing Address - Fax:
Practice Address - Street 1:4743 CLEMENS ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-8702
Practice Address - Country:US
Practice Address - Phone:561-255-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9235535363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health