Healthcare Provider Details

I. General information

NPI: 1396267852
Provider Name (Legal Business Name): REGINE GONEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OSPREY BLVD
BARTOW FL
33830-3308
US

IV. Provider business mailing address

4798 S FLORIDA AVE PMB # 341
LAKELAND FL
33813-2181
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME142250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: