Healthcare Provider Details

I. General information

NPI: 1376394346
Provider Name (Legal Business Name): FATIMA NIAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 08/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 SW 17TH RD
GAINESVILLE FL
32607-1000
US

IV. Provider business mailing address

7485 SW 17TH RD
GAINESVILLE FL
32607-1000
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5700
  • Fax: 352-333-4975
Mailing address:
  • Phone: 352-333-5700
  • Fax: 352-333-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: