Provider Demographics
NPI:1003688383
Name:FRAGOSO, MILADYS IVETTE (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:MILADYS
Middle Name:IVETTE
Last Name:FRAGOSO
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 EISENHOWER ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-9707
Mailing Address - Country:US
Mailing Address - Phone:606-585-8523
Mailing Address - Fax:941-444-9540
Practice Address - Street 1:4810 US HIGHWAY 92 E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-9494
Practice Address - Country:US
Practice Address - Phone:941-444-9540
Practice Address - Fax:863-377-2849
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTC-8019246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty