=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023041761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE N ROMERO DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 09/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD SUITE 2260
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-514-7315
-----------------------------------------------------
Fax | 239-514-7304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD STE 1170
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-514-7315
-----------------------------------------------------
Fax | 239-514-7304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS8202
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------