Provider Demographics
NPI:1033880760
Name:ROMAN, REBECCA DALILA (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DALILA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRYANT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1811
Mailing Address - Country:US
Mailing Address - Phone:732-597-4061
Mailing Address - Fax:
Practice Address - Street 1:4 BRYANT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1811
Practice Address - Country:US
Practice Address - Phone:732-597-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01190800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner