Healthcare Provider Details

I. General information

NPI: 1639315161
Provider Name (Legal Business Name): GRETCHEN SANMIGUEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S HARBOUR ISLAND BLVD STE 109
TAMPA FL
33602-5927
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 109
TAMPA FL
33602-5927
US

V. Phone/Fax

Practice location:
  • Phone: 407-587-9113
  • Fax: 813-565-1578
Mailing address:
  • Phone: 407-587-9113
  • Fax: 813-565-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME103178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: