Healthcare Provider Details

I. General information

NPI: 1598695173
Provider Name (Legal Business Name): MIA ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 GALE LEMERAND DR
GAINESVILLE FL
32610-3008
US

IV. Provider business mailing address

15352 HAMLIN BLVD
LOXAHATCHEE FL
33470-2853
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberNONE
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: