Provider Demographics
NPI:1699923102
Name:TACTUK ROMANENKO, NANCY M (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:TACTUK ROMANENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:TACTUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1015 RICE VALLEY RD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2782
Mailing Address - Country:US
Mailing Address - Phone:205-349-1606
Mailing Address - Fax:205-349-3263
Practice Address - Street 1:1015 RICE VALLEY RD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-349-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 31064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I111206Medicare PIN