Provider Demographics
NPI:1043023252
Name:ROMAN MARENGO, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROMAN MARENGO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3-52 CALDERON DE LA BARCA
Mailing Address - Street 2:URB HUCARES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6801
Mailing Address - Country:US
Mailing Address - Phone:787-306-0332
Mailing Address - Fax:
Practice Address - Street 1:W3-52 CALDERON DE LA BARCA
Practice Address - Street 2:URB HUCARES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6801
Practice Address - Country:US
Practice Address - Phone:787-306-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5638-PA363LP0808X
CO1701368163W00000X
CO1000502363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse