Provider Demographics
NPI:1841959103
Name:ROMAN, ALYSSA D (AGACNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:ROMAN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:D
Other - Last Name:GEORGAKLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1947 WHITE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1734
Mailing Address - Country:US
Mailing Address - Phone:732-616-8260
Mailing Address - Fax:
Practice Address - Street 1:1947 WHITE KNOLL DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1734
Practice Address - Country:US
Practice Address - Phone:732-616-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01246300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care