Provider Demographics
NPI:1144326521
Name:ROMAN, MARITZA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-4040
Mailing Address - Country:US
Mailing Address - Phone:956-795-4910
Mailing Address - Fax:956-795-2419
Practice Address - Street 1:2600 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4040
Practice Address - Country:US
Practice Address - Phone:956-795-4910
Practice Address - Fax:956-795-2419
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174393201Medicaid
TX174393201Medicaid