Healthcare Provider Details

I. General information

NPI: 1912609371
Provider Name (Legal Business Name): MIRANDA PFAUTSCH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/25/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SW 62ND BLVD
GAINESVILLE FL
32607-6030
US

IV. Provider business mailing address

200 SW 62ND BLVD
GAINESVILLE FL
32607-6030
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-8211
  • Fax:
Mailing address:
  • Phone: 352-376-8211
  • Fax:

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: