Provider Demographics
NPI:1306165485
Name:LO, ROMINA (FNP-C)
Entity type:Individual
Prefix:
First Name:ROMINA
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ROMINA
Other - Middle Name:
Other - Last Name:LO-MONTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4280 N ORACLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-2101
Mailing Address - Country:US
Mailing Address - Phone:520-887-0095
Mailing Address - Fax:
Practice Address - Street 1:4280 N ORACLE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-2101
Practice Address - Country:US
Practice Address - Phone:520-887-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ596577Medicaid
47-2384286OtherTAX ID