Provider Demographics
NPI:1588115109
Name:TREMBLAY, ROMA
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:
Last Name:TREMBLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9207
Mailing Address - Country:US
Mailing Address - Phone:813-929-5436
Mailing Address - Fax:813-929-5317
Practice Address - Street 1:2600 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9207
Practice Address - Country:US
Practice Address - Phone:813-929-5436
Practice Address - Fax:813-929-5317
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9237451OtherMEDICAL LICENSE NUMBER
FLBN539OtherBCBS
FLARNP9237451OtherMEDICAL LICENSE NUMBER