Healthcare Provider Details

I. General information

NPI: 1770161820
Provider Name (Legal Business Name): FATIMA CHAGANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 NEWBERRY RD STE 301
GAINESVILLE FL
32607-2557
US

IV. Provider business mailing address

4340 NEWBERRY RD STE 301
GAINESVILLE FL
32607-2557
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-9414
  • Fax:
Mailing address:
  • Phone: 352-372-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME183074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: