Healthcare Provider Details

I. General information

NPI: 1205920410
Provider Name (Legal Business Name): MAUREEN JORDAN MACIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE STE 126
TAMPA FL
33613-4613
US

IV. Provider business mailing address

16551 HUTCHISON RD
ODESSA FL
33556-2324
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4280
  • Fax: 813-467-4281
Mailing address:
  • Phone: 813-410-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME96694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: