Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 11003106 | FL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11003106 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 11003106 | FL |
NPI | 1013569748 |
---|---|
Provider Name | Jan Michelle Lomanta Roflo |
First Address | Beverly Hills, FL 34465-3008 |
Second Address | Crystal River, FL 34429-7558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |