NPIMap

Individual provider Active NPI

Tylie Danielle Roman, CNP

  • Gerontology Nurse Practitioner
  • Nampa, ID
National Provider Identifier
1740981943
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
60660 Issued in ID
Practice address
1510 12TH Ave Rd Ste 200
Nampa, ID 83686-6946
Phone
(208) 302-6000
Fax
(208) 302-5455
NPI assigned
Mar 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 60660 ID
Acute Care Nurse Practitioner 363LA2100X 60660 ID
Gerontology Nurse Practitioner 363LG0600X 60660 ID Primary

Addresses

Primary practice location

1510 12TH Ave Rd Ste 200
Nampa, ID 83686-6946

Mailing address

3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 367-5170

Other practice location 1

323 E Riverside Dr Ste 224
Eagle, ID 83616-6865
Phone (208) 302-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230515001240 ID Practitioner - Nurse Practitioner 5092171231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1510 12TH Ave Rd
Suite 200
Nampa, ID 83686-6008
Phone (208) 302-6899

1512 12TH Ave Rd
Suite 100
Nampa, ID 83686-6008
Phone (208) 467-1171

215 E Hawaii Ave
Nampa, ID 83686-6011

3025 W Cherry LN
Meridian, ID 83642-8531

323 E Riverside Dr
Suite 224
Eagle, ID 83616-6865
Phone (208) 302-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
60660IDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jun 1, 2023 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Jun 1, 2023 Accepting new patients

Locations

323 E Riverside Dr
Ste 224
Eagle, ID 83616
Phone (208) 302-6000

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

1510 12th Ave Rd
Ste 200
Nampa, ID 83686
Phone (208) 302-0600

Interoperability endpoints

  • Direct secure messaging: troman2696438@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1740981943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 12TH AVE RD STE 200",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866946",
            "telephone_number": "208-302-6000",
            "fax_number": "208-302-5455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 E Riverside Dr Ste 224",
            "address_purpose": "LOCATION",
            "city": "Eagle",
            "state": "ID",
            "postal_code": "836166865",
            "country_code": "US",
            "telephone_number": "208-302-6000",
            "fax_number": "208-302-6055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "TYLIE",
        "middle_name": "DANIELLE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-14",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "60660",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "ID",
            "license": "60660",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ID",
            "license": "60660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.