Healthcare Provider Details

I. General information

NPI: 1609817014
Provider Name (Legal Business Name): MYRA WINN ALFINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIMI WINN ALFINO

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

4228 SW 78TH ST
GAINESVILLE FL
32608-4217
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-1340
  • Fax: 352-334-1348
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME50252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: